Provider Demographics
NPI:1043045107
Name:RILEY, SIDNEY MISCHEL (LLPC)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:MISCHEL
Last Name:RILEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 RIVERWALK CIR APT 6B
Mailing Address - Street 2:
Mailing Address - City:CORUNNA
Mailing Address - State:MI
Mailing Address - Zip Code:48817-1290
Mailing Address - Country:US
Mailing Address - Phone:360-843-6253
Mailing Address - Fax:
Practice Address - Street 1:215 N WATER ST STE 138
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2807
Practice Address - Country:US
Practice Address - Phone:810-230-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022206101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor