Provider Demographics
NPI:1063979144
Name:NEW RIVER COUNSELING, PLLC
Entity type:Organization
Organization Name:NEW RIVER COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SILLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-359-3269
Mailing Address - Street 1:167 N DRAKE RD # 19788
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9998
Mailing Address - Country:US
Mailing Address - Phone:269-359-3269
Mailing Address - Fax:
Practice Address - Street 1:2663 44TH ST SW STE 106
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4189
Practice Address - Country:US
Practice Address - Phone:269-359-3269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341719Medicaid