MEDICARE: MR. STEVE K RILEY MA, LPC

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	101YP2500X	Professional Counselor	3779	ID

General Provider Information

NPI Number	:	1598958159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVE K RILEY MA, LPC

Provider Business Mailing Address
First Line	:	PO BOX 1083
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-1083
Country	:	US
Telephone Number	:	208-587-8095
Fax Number	:	208-587-8025

Provider Business Practice Location Address
First Line	:	2390 AMERICAN LEGION BLVD
Second Line	:	SUITE 2
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-3109
Country	:	US
Telephone Number	:	208-587-8095
Fax Number	:	208-587-8025

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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