Provider Demographics
NPI:1699372631
Name:RIVER CITY MUSIC THERAPY, LLC
Entity Type:Organization
Organization Name:RIVER CITY MUSIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:FITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MME, MT-BC
Authorized Official - Phone:309-826-2679
Mailing Address - Street 1:1807 W MOSS AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1646
Mailing Address - Country:US
Mailing Address - Phone:309-826-2679
Mailing Address - Fax:
Practice Address - Street 1:1504 W MOSS AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1638
Practice Address - Country:US
Practice Address - Phone:309-826-2679
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty