Provider Demographics
NPI:1356237952
Name:SUNRIVER PSYCHOTHERAPY
Entity type:Organization
Organization Name:SUNRIVER PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHYANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:219-508-8266
Mailing Address - Street 1:8465 KEYSTONE CROSSING, SUITE 115 #2028
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-527-4229
Mailing Address - Fax:317-536-5555
Practice Address - Street 1:2701 OXFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2545
Practice Address - Country:US
Practice Address - Phone:219-508-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty