Organization
RIVERSIDE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYNN TANNER LCSW (OWNER)
(907) 987-5088
Entity
Organization
Contact information
Practice address
250 CUSHMAN ST STE 4F, FAIRBANKS, AK 99701-4665
(907) 987-5088
Mailing address
250 CUSHMAN ST STE 4F, FAIRBANKS, AK 99701-4665
(907) 987-5088
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
05/19/2019
Last updated
05/19/2019
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