Provider Demographics
NPI:1588923197
Name:RILEY, ANDREW R SR
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:R
Last Name:RILEY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4569 COGNAC CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7803
Mailing Address - Country:US
Mailing Address - Phone:901-314-9607
Mailing Address - Fax:901-794-3539
Practice Address - Street 1:4572 COGNAC CV
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7803
Practice Address - Country:US
Practice Address - Phone:901-794-5682
Practice Address - Fax:901-794-3539
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor