Provider Demographics
NPI:1932690328
Name:RIVERSIDE FAMILY COUNSELING, LLC
Entity Type:Organization
Organization Name:RIVERSIDE FAMILY COUNSELING, LLC
Other - Org Name:RIVERSIDE FAMILY COUNSELING, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-316-8292
Mailing Address - Street 1:497 SW CENTURY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1167
Mailing Address - Country:US
Mailing Address - Phone:541-316-8292
Mailing Address - Fax:541-318-0058
Practice Address - Street 1:497 SW CENTURY DR STE 102
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1167
Practice Address - Country:US
Practice Address - Phone:541-316-8292
Practice Address - Fax:541-318-0058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty