Provider Demographics
NPI:1528383452
Name:RIDGEVIEW COUNSELING AND FAMILY THERAPY GROUP LLC
Entity Type:Organization
Organization Name:RIDGEVIEW COUNSELING AND FAMILY THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RUDOLPH
Authorized Official - Last Name:FREDA
Authorized Official - Suffix:
Authorized Official - Credentials:MFT, LADC
Authorized Official - Phone:775-823-4080
Mailing Address - Street 1:3650 WARREN WAY
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5240
Mailing Address - Country:US
Mailing Address - Phone:775-823-4080
Mailing Address - Fax:775-823-4099
Practice Address - Street 1:3650 WARREN WAY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5240
Practice Address - Country:US
Practice Address - Phone:775-823-4080
Practice Address - Fax:775-823-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-03
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0791106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty