Provider Demographics
NPI:1861625261
Name:WHITE RIVER COUNSELING, LLC
Entity type:Organization
Organization Name:WHITE RIVER COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:VIGNEUX
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:970-625-3416
Mailing Address - Street 1:758 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3552
Mailing Address - Country:US
Mailing Address - Phone:970-625-3416
Mailing Address - Fax:
Practice Address - Street 1:758 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3552
Practice Address - Country:US
Practice Address - Phone:970-625-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1090-00251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health