Provider Demographics
NPI:1891933743
Name:RIVER OF LIFE COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:RIVER OF LIFE COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:ELGIN
Authorized Official - Suffix:
Authorized Official - Credentials:LLC
Authorized Official - Phone:414-550-0659
Mailing Address - Street 1:216 GREEN BAY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-1658
Mailing Address - Country:US
Mailing Address - Phone:414-550-0659
Mailing Address - Fax:262-242-1714
Practice Address - Street 1:216 GREEN BAY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:THIENSVILLE
Practice Address - State:WI
Practice Address - Zip Code:53092-1658
Practice Address - Country:US
Practice Address - Phone:414-550-0659
Practice Address - Fax:262-242-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40969700OtherMEDICARE
WI189-125OtherLPC