Provider Demographics
NPI:1598958159
Name:RILEY, STEVE K (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:STEVE
Middle Name:K
Last Name:RILEY
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1083
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-1083
Mailing Address - Country:US
Mailing Address - Phone:208-587-8095
Mailing Address - Fax:208-587-8025
Practice Address - Street 1:2390 AMERICAN LEGION BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3109
Practice Address - Country:US
Practice Address - Phone:208-587-8095
Practice Address - Fax:208-587-8025
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional