Provider Demographics
NPI:1033356522
Name:RIVERO, SARA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:MARIE
Last Name:RIVERO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:MARIE
Other - Last Name:DESIREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 N GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74120-1443
Mailing Address - Country:US
Mailing Address - Phone:918-640-0684
Mailing Address - Fax:
Practice Address - Street 1:130 N GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1443
Practice Address - Country:US
Practice Address - Phone:918-640-0684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-21
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3812101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional