Provider Demographics
NPI:1053299073
Name:LIVING RIVERS MENTAL HEALTH LLC
Entity type:Organization
Organization Name:LIVING RIVERS MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELLENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:606-383-1189
Mailing Address - Street 1:378 MEADOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6245
Mailing Address - Country:US
Mailing Address - Phone:606-383-1189
Mailing Address - Fax:
Practice Address - Street 1:378 MEADOWCREST DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6245
Practice Address - Country:US
Practice Address - Phone:606-383-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty