Provider Demographics
NPI:1114485984
Name:RIVAS, STORM (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:STORM
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 NW LOOP 410 STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2325
Mailing Address - Country:US
Mailing Address - Phone:210-733-7117
Mailing Address - Fax:
Practice Address - Street 1:11306 SIR WINSTON ST BLDG F
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2467
Practice Address - Country:US
Practice Address - Phone:210-366-0049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX86854101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician