Provider Demographics
NPI:1881710200
Name:THE RIVERS FAMILY THERAPY CENTER, LLC
Entity type:Organization
Organization Name:THE RIVERS FAMILY THERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MURNANE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:608-784-4005
Mailing Address - Street 1:315 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-5273
Mailing Address - Country:US
Mailing Address - Phone:608-784-4005
Mailing Address - Fax:608-406-2025
Practice Address - Street 1:505 KING ST
Practice Address - Street 2:SUITE 38
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-9204
Practice Address - Country:US
Practice Address - Phone:608-784-4005
Practice Address - Fax:608-406-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4904-120104100000X
MN33271041C0700X
WI2008-1231041C0700X
MN202106H00000X
WI325-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty