Provider Demographics
NPI:1700633237
Name:RIVERSTONE THERAPY LLC
Entity Type:Organization
Organization Name:RIVERSTONE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIMARY PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CADC II
Authorized Official - Phone:530-400-9736
Mailing Address - Street 1:937 WHITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3704
Mailing Address - Country:US
Mailing Address - Phone:530-400-9736
Mailing Address - Fax:
Practice Address - Street 1:937 WHITMAN AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3704
Practice Address - Country:US
Practice Address - Phone:530-400-9736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVERSTONE THERAPY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-02
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)