Provider Demographics
NPI:1619599636
Name:RIVERS WAY TRAINING CLINIC
Entity Type:Organization
Organization Name:RIVERS WAY TRAINING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRERCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:REISS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:541-206-0964
Mailing Address - Street 1:412 W 17TH
Mailing Address - Street 2:
Mailing Address - City:EUGENA
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-8060
Mailing Address - Fax:541-687-6647
Practice Address - Street 1:2049 NW HOYT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209
Practice Address - Country:US
Practice Address - Phone:503-321-5127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health