Provider Demographics
NPI:1285180539
Name:RIVER STREET COUNSELING SERVICES, PLLC
Entity type:Organization
Organization Name:RIVER STREET COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIYASOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-556-7267
Mailing Address - Street 1:200 N. RIVER STREET
Mailing Address - Street 2:STE. 100-H
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5607
Mailing Address - Country:US
Mailing Address - Phone:830-556-7267
Mailing Address - Fax:
Practice Address - Street 1:200 N. RIVER STREET
Practice Address - Street 2:STE. 100-H
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5607
Practice Address - Country:US
Practice Address - Phone:830-556-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71110101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty