Provider Demographics
NPI:1023555026
Name:RIVERA HYDE, TAMARA LIZ (LMHC)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LIZ
Last Name:RIVERA HYDE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LIZ
Other - Last Name:RIVERA BORIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1318 SIDEWINDER RD NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2587
Mailing Address - Country:US
Mailing Address - Phone:770-866-4382
Mailing Address - Fax:
Practice Address - Street 1:1318 SIDEWINDER RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-2587
Practice Address - Country:US
Practice Address - Phone:770-866-4382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-27
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
221700000X
NMT-CTL0207281101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist