Provider Demographics
NPI:1952188369
Name:ANTHONY RISKE COUNSELING LLC
Entity Type:Organization
Organization Name:ANTHONY RISKE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:NATHAN
Authorized Official - Last Name:RISKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:720-739-0278
Mailing Address - Street 1:2905 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-5221
Mailing Address - Country:US
Mailing Address - Phone:720-739-0278
Mailing Address - Fax:
Practice Address - Street 1:2905 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-5221
Practice Address - Country:US
Practice Address - Phone:720-739-0278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1962165340Medicaid