Provider Demographics
NPI:1881046191
Name:RIVERSTONE BEHAVIORAL HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:RIVERSTONE BEHAVIORAL HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:469-992-6294
Mailing Address - Street 1:5300 W PLANO PKWY
Mailing Address - Street 2:SUITE 100, #102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 W PLANO PKWY
Practice Address - Street 2:SUITE 100, #102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4863
Practice Address - Country:US
Practice Address - Phone:469-992-6294
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1487996419OtherNPI 1