Provider Demographics
NPI:1215306949
Name:RIVERPLACE COUNSELING & WELLNESS
Entity type:Organization
Organization Name:RIVERPLACE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLINN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-750-1802
Mailing Address - Street 1:312 MILLER ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1944
Mailing Address - Country:US
Mailing Address - Phone:208-750-1802
Mailing Address - Fax:208-750-1803
Practice Address - Street 1:312 MILLER ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1944
Practice Address - Country:US
Practice Address - Phone:208-750-1802
Practice Address - Fax:208-750-1803
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERPLACE COUNSELING & WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC5413101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty