Provider Demographics
NPI:1063682458
Name:RIO VISTA COUNSELING
Entity Type:Organization
Organization Name:RIO VISTA COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SPEAKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-507-4408
Mailing Address - Street 1:1400 BARBARA LOOP SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-1088
Mailing Address - Country:US
Mailing Address - Phone:505-507-4408
Mailing Address - Fax:505-867-6059
Practice Address - Street 1:1400 BARBARA LOOP SE
Practice Address - Street 2:SUITE D
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1088
Practice Address - Country:US
Practice Address - Phone:505-507-4408
Practice Address - Fax:505-867-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35473011Medicaid
NMVNM012413PSMedicaid
NM1255457339Medicaid
NMVNM012413PXMedicaid
NMVNM012413OTMedicaid
NMVNM012413NIMedicaid
NMVNM012413NOMedicaid