Provider Demographics
NPI:1427502855
Name:RIPPLING WATERS COUNSELING PLLC
Entity type:Organization
Organization Name:RIPPLING WATERS COUNSELING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:MARY JEAN
Authorized Official - Last Name:MOSBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:618-939-3919
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-0151
Mailing Address - Country:US
Mailing Address - Phone:618-939-3919
Mailing Address - Fax:618-939-3920
Practice Address - Street 1:220 BRADFORD LN STE C
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3370
Practice Address - Country:US
Practice Address - Phone:618-939-3919
Practice Address - Fax:618-939-3920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X, 1041C0700X
IL149-0021181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300270041OtherMEDICARE PTAN