MEDICARE: RIVERSTONE COUNSELING & CRISIS SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	3101	WI
2	1041C0700X	Clinical Social Worker	8016-123	WI

General Provider Information

NPI Number	:	1447687066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSTONE COUNSELING & CRISIS SERVICES, LLC

Provider Business Mailing Address
First Line	:	8018 W CAPITOL DR
Second Line	:	UNIT 6
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-559-8864
Fax Number	:

Provider Business Practice Location Address
First Line	:	8018 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-1906
Country	:	US
Telephone Number	:	414-559-8864
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/THERAPIST
Name	:	SARA J NEWMAN
Credential	:	LCSW
Telephone Number	:	414-559-8864

Provider Enumeration Date	:	09/27/2013
Last Update Date	:	11/13/2015

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