| Russian River Counselors | |
|
709 Davis St Santa Rosa CA 95401-4767 | |
| (707) 525-9223 | |
| Not Available |
| Full Name | Russian River Counselors |
|---|---|
| Speciality | Psychologist - Group Psychotherapy |
| Location | 709 Davis St, Santa Rosa, California |
| Authorized Official Name and Position | Antonio Madrid (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7078651200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Russian River Counselors Po Box 519 Monte Rio CA 95462-0519 Ph: (707) 865-1200 | Russian River Counselors 709 Davis St Santa Rosa CA 95401-4767 Ph: (707) 525-9223 |
| NPI Number | 1154768307 |
|---|---|
| Provider Enumeration Date | 05/29/2013 |
| Last Update Date | 05/29/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154768307 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | 110000330 (California) | Primary |
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