Provider Demographics
NPI:1407284615
Name:RIVERVIEW BEHAVIOR HEALTH SERVICES
Entity Type:Organization
Organization Name:RIVERVIEW BEHAVIOR HEALTH SERVICES
Other - Org Name:MICHELLE JOHNSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:601-218-7041
Mailing Address - Street 1:1905 MISSION 66 # B
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3751
Mailing Address - Country:US
Mailing Address - Phone:601-883-7000
Mailing Address - Fax:
Practice Address - Street 1:1905 MISSION 66 # B
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3751
Practice Address - Country:US
Practice Address - Phone:601-883-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization