Provider Demographics
NPI:1902692809
Name:RIVERSIDE COUNSELING LLC
Entity type:Organization
Organization Name:RIVERSIDE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DELANEY
Authorized Official - Middle Name:BREANNE
Authorized Official - Last Name:OBALDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:208-410-8564
Mailing Address - Street 1:6853 N ROE AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2191
Mailing Address - Country:US
Mailing Address - Phone:951-398-9720
Mailing Address - Fax:
Practice Address - Street 1:1491 S TYRELL LN STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4032
Practice Address - Country:US
Practice Address - Phone:208-410-8564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty