Provider Demographics
NPI:1164137170
Name:RIVER HOLLOW MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:RIVER HOLLOW MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:HUNSAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:435-538-2152
Mailing Address - Street 1:975 THRUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4825
Mailing Address - Country:US
Mailing Address - Phone:435-538-2152
Mailing Address - Fax:
Practice Address - Street 1:975 THRUSHWOOD DR
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4825
Practice Address - Country:US
Practice Address - Phone:435-538-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty