Provider Demographics
NPI:1275545477
Name:RIVERSIDE COUNSELING, TESTING & EDUCATIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:RIVERSIDE COUNSELING, TESTING & EDUCATIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOLLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-527-8380
Mailing Address - Street 1:519 W DELAWARE ST
Mailing Address - Street 2:PO BOX 1613
Mailing Address - City:PURCELL
Mailing Address - State:OK
Mailing Address - Zip Code:73080-5242
Mailing Address - Country:US
Mailing Address - Phone:405-527-8380
Mailing Address - Fax:405-527-4549
Practice Address - Street 1:519 W DELAWARE ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-5242
Practice Address - Country:US
Practice Address - Phone:405-527-8380
Practice Address - Fax:405-527-4549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)