Provider Demographics
NPI:1275279655
Name:RIVER CITY THERAPY CENTER, LLC
Entity Type:Organization
Organization Name:RIVER CITY THERAPY CENTER, LLC
Other - Org Name:RIVER CITY THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KYLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALAUN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA
Authorized Official - Phone:651-360-3202
Mailing Address - Street 1:4911 LEARNING LN
Mailing Address - Street 2:
Mailing Address - City:RED WING
Mailing Address - State:MN
Mailing Address - Zip Code:55066-4533
Mailing Address - Country:US
Mailing Address - Phone:651-360-3202
Mailing Address - Fax:651-369-2833
Practice Address - Street 1:4911 LEARNING LN
Practice Address - Street 2:
Practice Address - City:RED WING
Practice Address - State:MN
Practice Address - Zip Code:55066-4533
Practice Address - Country:US
Practice Address - Phone:651-360-3202
Practice Address - Fax:651-369-2833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-09
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty