Provider Demographics
NPI:1376157453
Name:RIVER ROCK BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:RIVER ROCK BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-408-7676
Mailing Address - Street 1:50 CRESTWOOD EXECUTIVE CTR STE 308
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1900
Mailing Address - Country:US
Mailing Address - Phone:314-408-7676
Mailing Address - Fax:314-328-5453
Practice Address - Street 1:777 S NEW BALLAS RD STE 129W
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8745
Practice Address - Country:US
Practice Address - Phone:314-408-7676
Practice Address - Fax:314-328-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-04
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty