Provider Demographics
NPI:1902514516
Name:RIVERWALK COUNSELING CENTER LLC
Entity type:Organization
Organization Name:RIVERWALK COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:APHRODITE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC
Authorized Official - Phone:443-869-0357
Mailing Address - Street 1:404 BRADLEY BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4500
Mailing Address - Country:US
Mailing Address - Phone:443-869-0357
Mailing Address - Fax:800-801-0532
Practice Address - Street 1:404 BRADLEY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4500
Practice Address - Country:US
Practice Address - Phone:443-869-0357
Practice Address - Fax:800-801-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA00011009OtherWASHINGTON STATE DEPARTMENT OF HEALTH