Provider Demographics
NPI:1407977176
Name:RILEY, MOLLY K
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:K
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 SANTA BARBARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4451
Mailing Address - Country:US
Mailing Address - Phone:650-387-2230
Mailing Address - Fax:
Practice Address - Street 1:956 CHORRO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3202
Practice Address - Country:US
Practice Address - Phone:805-544-4967
Practice Address - Fax:805-544-4968
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health