Provider Demographics
NPI:1568903706
Name:RIVER CITIES COUNSELING & CONSULTING INC
Entity Type:Organization
Organization Name:RIVER CITIES COUNSELING & CONSULTING INC
Other - Org Name:RIVER CITIES COUNSELING INC
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED MARRIAGE & FAMILY THERAPIS
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FORTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-223-5779
Mailing Address - Street 1:PO BOX 492551
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-2551
Mailing Address - Country:US
Mailing Address - Phone:530-223-5779
Mailing Address - Fax:
Practice Address - Street 1:643 BLACKBURN AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-2216
Practice Address - Country:US
Practice Address - Phone:530-824-4408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 35841251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health