Provider Demographics
NPI:1124691134
Name:RIVERSIDE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:RIVERSIDE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:417-861-2744
Mailing Address - Street 1:2753 W FISHHOOK AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-6798
Mailing Address - Country:US
Mailing Address - Phone:417-861-2744
Mailing Address - Fax:
Practice Address - Street 1:2753 W FISHHOOK AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-6798
Practice Address - Country:US
Practice Address - Phone:417-861-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health