Provider Demographics
NPI:1053953174
Name:RIVERUNBROKEN TRAUMA COUNSELING, PLLC
Entity type:Organization
Organization Name:RIVERUNBROKEN TRAUMA COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:DESTINY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:832-280-4054
Mailing Address - Street 1:5870 HIGHWAY 6 N STE 311
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-1857
Mailing Address - Country:US
Mailing Address - Phone:832-280-4054
Mailing Address - Fax:832-280-9919
Practice Address - Street 1:5870 HIGHWAY 6 N STE 311
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-1857
Practice Address - Country:US
Practice Address - Phone:832-280-4054
Practice Address - Fax:832-280-9919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty