Provider Demographics
NPI:1619528940
Name:RIVER TRAIL COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:RIVER TRAIL COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEETOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC
Authorized Official - Phone:248-563-7288
Mailing Address - Street 1:70 S SQUIRREL RD STE D
Mailing Address - Street 2:
Mailing Address - City:AUBURN HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48326-3280
Mailing Address - Country:US
Mailing Address - Phone:248-289-1894
Mailing Address - Fax:248-564-2650
Practice Address - Street 1:705 BARCLAY CIR STE 125
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-4575
Practice Address - Country:US
Practice Address - Phone:248-983-9136
Practice Address - Fax:248-856-9328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty