Provider Demographics
NPI:1588235188
Name:RIVERWALK THERAPY, PLLC
Entity Type:Organization
Organization Name:RIVERWALK THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:435-327-2630
Mailing Address - Street 1:169 W 2710 SOUTH CIR STE 203E
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7251
Mailing Address - Country:US
Mailing Address - Phone:435-429-2630
Mailing Address - Fax:
Practice Address - Street 1:169 W 2710 SOUTH CIR STE 203E
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7251
Practice Address - Country:US
Practice Address - Phone:435-429-2630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)