Provider Demographics
NPI:1053468603
Name:RIVERS, NECOLE
Entity Type:Individual
Prefix:
First Name:NECOLE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 CANYON CREEK DR STE 105
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3278
Mailing Address - Country:US
Mailing Address - Phone:254-338-3175
Mailing Address - Fax:254-265-7061
Practice Address - Street 1:1023 CANYON CREEK DR STE 105
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3278
Practice Address - Country:US
Practice Address - Phone:254-338-3175
Practice Address - Fax:254-265-7061
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37382103TC0700X, 103T00000X
TX111722225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics