Provider Demographics
NPI:1427421957
Name:RIVER VALLEY BEHAVIOR HEALTH & WELLNESS CENTER
Entity type:Organization
Organization Name:RIVER VALLEY BEHAVIOR HEALTH & WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:952-746-7664
Mailing Address - Street 1:8640 EAGLE CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-4400
Mailing Address - Country:US
Mailing Address - Phone:952-746-7664
Mailing Address - Fax:952-224-4867
Practice Address - Street 1:8640 EAGLE CREEK CIR
Practice Address - Street 2:
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378-4400
Practice Address - Country:US
Practice Address - Phone:952-746-7664
Practice Address - Fax:952-224-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC1053101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC1053OtherBOARD OF BEHAVIOR HEALTH & THERAPY