Provider Demographics
NPI:1912788357
Name:PRAIRIE RIVER THERAPY AND ASSESSMENTS
Entity Type:Organization
Organization Name:PRAIRIE RIVER THERAPY AND ASSESSMENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENNAN
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:ATHERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-717-0405
Mailing Address - Street 1:3710 26TH ST W APT 3304
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5373
Mailing Address - Country:US
Mailing Address - Phone:801-717-0405
Mailing Address - Fax:
Practice Address - Street 1:3710 26TH ST W APT 3304
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5373
Practice Address - Country:US
Practice Address - Phone:801-717-0405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty