Provider Demographics
NPI:1881727584
Name:RISLEY, G. DENVER (LPCC AND LCDC III)
Entity type:Individual
Prefix:
First Name:G.
Middle Name:DENVER
Last Name:RISLEY
Suffix:
Gender:M
Credentials:LPCC AND LCDC III
Other - Prefix:
Other - First Name:DENNY
Other - Middle Name:
Other - Last Name:RISLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC III AND LPCC
Mailing Address - Street 1:7193 WETHERSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8880
Mailing Address - Country:US
Mailing Address - Phone:513-379-8998
Mailing Address - Fax:513-677-3185
Practice Address - Street 1:6107 SOUTH RT # 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039
Practice Address - Country:US
Practice Address - Phone:513-379-8998
Practice Address - Fax:513-677-3185
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051005101YA0400X
OHE-0001231101YP2500X
OHS-0019472104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker