Provider Demographics
NPI:1194179853
Name:RIVER CITY COUNSELING, LLC
Entity type:Organization
Organization Name:RIVER CITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PFENNING
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LCPC
Authorized Official - Phone:208-699-0679
Mailing Address - Street 1:1362 N GEMSTONE PL
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5470
Mailing Address - Country:US
Mailing Address - Phone:208-699-0679
Mailing Address - Fax:
Practice Address - Street 1:1362 N GEMSTONE PL
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5470
Practice Address - Country:US
Practice Address - Phone:208-699-0679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-4662251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health