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NPI Code Detail

MEDICARE: RIVER VALLEY COUNSELING, LLC

MEDICARE: RIVER VALLEY COUNSELING, 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
1101YM0800XMental Health Counselor

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
39360171OTHEROHMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000385283OTHEROHANTHEM BCBS
2829430 000OTHEROHMAGELLAN BEHAVIOR HEALTH

General Provider Information

NPI Number : 1548214752
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER VALLEY COUNSELING, LLC
Provider Business Mailing Address
First Line : 131 N EWING ST
Second Line : UNIT B
City : LANCASTER
State : OH
Zip : 43130-3383
Country : US
Telephone Number : 740-689-6700
Fax Number : 740-689-6702
Provider Business Practice Location Address
First Line : 131 N EWING ST
Second Line : UNIT B
City : LANCASTER
State : OH
Zip : 43130-3383
Country : US
Telephone Number : 740-689-6700
Fax Number : 740-689-6702
Authorized Official
Title or Position : BILLING MANAGER
Name : DIANNA BERRY
Credential :
Telephone Number : 740-689-6700
Provider Enumeration Date : 05/20/2006
Last Update Date : 12/30/2014

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Directions to “RIVER VALLEY COUNSELING, LLC ” Practice Location

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