Provider Demographics
NPI:1275568271
Name:RIVER VALLEY PSYCHOLOGICAL SERVICES INC
Entity Type:Organization
Organization Name:RIVER VALLEY PSYCHOLOGICAL SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LABOUNTY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LP
Authorized Official - Phone:715-425-8899
Mailing Address - Street 1:215 N 2ND ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54022
Mailing Address - Country:US
Mailing Address - Phone:715-425-8899
Mailing Address - Fax:715-425-5590
Practice Address - Street 1:215 N 2ND ST
Practice Address - Street 2:SUITE 101
Practice Address - City:RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54022
Practice Address - Country:US
Practice Address - Phone:715-425-8899
Practice Address - Fax:715-425-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN08627RIOtherBLUE CROSS BLUE SHIELD
WI42174700Medicaid
WI=========014OtherBLUE CROSS BLUE SHIELD