MEDICARE: RIVER PINES 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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1730828245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER PINES COUNSELING LLC

Provider Business Mailing Address
First Line	:	105 NEW ENGLAND PL STE 150
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-2036
Country	:	US
Telephone Number	:	952-250-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 NEW ENGLAND PL STE 150
Second Line	:
City	:	STILLWATER
State	:	MN
Zip	:	55082-2036
Country	:	US
Telephone Number	:	952-250-0909
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROD STIVLAND
Credential	:
Telephone Number	:	952-250-0909

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “RIVER PINES COUNSELING LLC ” Practice Location

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