Provider Demographics
NPI:1730553298
Name:RILEY, JANELL JULIE (LPC)
Entity type:Individual
Prefix:
First Name:JANELL
Middle Name:JULIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2224
Mailing Address - Country:US
Mailing Address - Phone:320-434-0190
Mailing Address - Fax:
Practice Address - Street 1:265 RIVER ST N
Practice Address - Street 2:STE 109
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-8266
Practice Address - Country:US
Practice Address - Phone:612-584-1153
Practice Address - Fax:763-972-8808
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN01642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional