Provider Demographics
NPI:1063033090
Name:RIVERINE THERAPY LLC
Entity Type:Organization
Organization Name:RIVERINE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:612-702-2456
Mailing Address - Street 1:12531 71ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:MOTLEY
Mailing Address - State:MN
Mailing Address - Zip Code:56466-2510
Mailing Address - Country:US
Mailing Address - Phone:612-702-2456
Mailing Address - Fax:
Practice Address - Street 1:12531 71ST AVE SW
Practice Address - Street 2:
Practice Address - City:MOTLEY
Practice Address - State:MN
Practice Address - Zip Code:56466-2510
Practice Address - Country:US
Practice Address - Phone:612-702-2456
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health