Provider Demographics
NPI:1376814137
Name:RIVERBEAR COUNSELING LLC
Entity Type:Organization
Organization Name:RIVERBEAR COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:575-756-1560
Mailing Address - Street 1:P.O. BOX 1241
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-1241
Mailing Address - Country:US
Mailing Address - Phone:575-756-1560
Mailing Address - Fax:575-756-1560
Practice Address - Street 1:16306 HWY 64/84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520
Practice Address - Country:US
Practice Address - Phone:575-209-1769
Practice Address - Fax:575-756-1560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0091811101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66931339Medicaid