Provider Demographics
NPI:1083480545
Name:RIVER THERAPY COLLECTIVE
Entity Type:Organization
Organization Name:RIVER THERAPY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:979-922-0278
Mailing Address - Street 1:1531 S ROCKFORD AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-6418
Mailing Address - Country:US
Mailing Address - Phone:979-922-0278
Mailing Address - Fax:
Practice Address - Street 1:1531 S ROCKFORD AVE APT 9
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-6418
Practice Address - Country:US
Practice Address - Phone:979-922-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty