Organization
INTENTIONAL SUSTAINABLE WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI L LARIVIERE MD (FOUNDER, PSYCHIATRY DIRECTOR)
(612) 723-6417
Entity
Organization
Contact information
Practice address
4127 NORD HWY, CHICO, CA 95973-9631
(612) 723-6417
Mailing address
4127 NORD HWY, CHICO, CA 95973-9631
(612) 723-6417
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4571750
ENTITY (FILE) NUMBER
CA
01
—
553997
CALIFORNIA MEDICAL BOARD FICTITIOUS NAME PERMIT (FNP)
CA
Enumeration date
05/10/2022
Last updated
05/10/2022
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