Provider Demographics
NPI:1740737204
Name:RIVER VIEW COUNSELING, PLLC
Entity type:Organization
Organization Name:RIVER VIEW COUNSELING, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ENTRICAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:970-531-1996
Mailing Address - Street 1:195 N 3RD ST.
Mailing Address - Street 2:POB 2274
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-2274
Mailing Address - Country:US
Mailing Address - Phone:970-531-1996
Mailing Address - Fax:970-557-3170
Practice Address - Street 1:195 THIRD STREET
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-531-1996
Practice Address - Fax:970-557-3170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7511101YA0400X
CO383106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO338133Medicaid