Provider Demographics
NPI:1346351269
Name:RIVER, LOUIS PHILIP IV (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:PHILIP
Last Name:RIVER
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:PHILIP
Other - Last Name:RIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:120 E OGDEN AVE
Mailing Address - Street 2:#220
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3546
Mailing Address - Country:US
Mailing Address - Phone:630-325-5300
Mailing Address - Fax:630-325-5309
Practice Address - Street 1:120 E OGDEN AVE
Practice Address - Street 2:#220
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3546
Practice Address - Country:US
Practice Address - Phone:630-325-5300
Practice Address - Fax:630-325-5309
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.012823101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional