Provider Demographics
NPI:1699110353
Name:RIVERSIDE COUNSELING, INC
Entity type:Organization
Organization Name:RIVERSIDE COUNSELING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-667-3515
Mailing Address - Street 1:408 E MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-3051
Mailing Address - Country:US
Mailing Address - Phone:208-667-3515
Mailing Address - Fax:208-667-1304
Practice Address - Street 1:408 E MONTANA AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-3051
Practice Address - Country:US
Practice Address - Phone:208-667-3515
Practice Address - Fax:208-667-1304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty