Provider Demographics
NPI:1043364854
Name:RILEY, JANET MARIE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 1-2 W. MULLAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701
Mailing Address - Country:US
Mailing Address - Phone:319-234-4625
Mailing Address - Fax:319-234-4625
Practice Address - Street 1:720 W MULLAN AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5925
Practice Address - Country:US
Practice Address - Phone:319-234-4625
Practice Address - Fax:319-234-4625
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health