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NPI Code Detail

MEDICARE: RIVERS END PLLC

MEDICARE: RIVERS END PLLC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1801758677
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERS END PLLC
Provider Business Mailing Address
First Line : 1620 FOUNTAIN LN N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55447-2722
Country : US
Telephone Number : 763-288-6723
Fax Number :
Provider Business Practice Location Address
First Line : 6385 OLD SHADY OAK RD STE 250
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-7705
Country : US
Telephone Number : 763-288-6723
Fax Number :
Authorized Official
Title or Position : THERAPIST AND OWNER
Name : ALYSSA CHRISTINE DEGIFE
Credential : MS CMHC LPCC
Telephone Number : 763-288-6723
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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