Organization Name: | SAC RIVER INSTITUTE |
NPI Number: | 1700139755 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | REBECCA MARIE ROLLER (CLINICAL PSYCHOLOGIST) |
Mailing Address: | 131 Elm Street Dadeville |
State: | MO US |
Postal Code: | 65635 |
Phone Number: | 4179952476 |
Fax Number: | 8665205586 |
NPI Enumeration Date: | 10/16/2012 |
NPI Last Update Date: | 10/16/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 2006033497 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |