Provider Demographics
NPI:1467206250
Name:RIVERWISE THERAPY PLLC
Entity Type:Organization
Organization Name:RIVERWISE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNLOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-530-1391
Mailing Address - Street 1:PO BOX 885
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-0885
Mailing Address - Country:US
Mailing Address - Phone:719-717-9094
Mailing Address - Fax:
Practice Address - Street 1:222 1/2 F ST STE 6
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-2141
Practice Address - Country:US
Practice Address - Phone:719-717-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty