1386099059 NPI number — RIVERBEND COUNSELING SERVICES, PLLC

Table of content: (NPI 1386099059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386099059 NPI number — RIVERBEND COUNSELING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERBEND COUNSELING SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386099059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 CENTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUTTON
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05867-9731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-745-9567
Provider Business Mailing Address Fax Number:
802-467-8621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
231 CONCORD AVE
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
ST JOHNSBURY
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05819-1513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-745-9567
Provider Business Practice Location Address Fax Number:
802-467-8621
Provider Enumeration Date:
04/29/2016

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
802-745-9567

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  000644 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 068.0069442 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com