Provider Demographics
NPI:1013156744
Name:LEONARD-RIVERS, CRISTY SUE (LPCC)
Entity type:Individual
Prefix:
First Name:CRISTY
Middle Name:SUE
Last Name:LEONARD-RIVERS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:MN
Mailing Address - Zip Code:55718-3700
Mailing Address - Country:US
Mailing Address - Phone:218-384-7008
Mailing Address - Fax:651-431-7679
Practice Address - Street 1:810 3RD ST STE 500
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:MN
Practice Address - Zip Code:55718-3700
Practice Address - Country:US
Practice Address - Phone:218-384-7008
Practice Address - Fax:651-431-7679
Is Sole Proprietor?:No
Enumeration Date:2009-02-19
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03858101YM0800X
NE1133101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47075636930Medicaid
NE47075636930Medicaid