Provider Demographics
NPI:1164706933
Name:RIVAS, ANTHONY L
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:L
Last Name:RIVAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9224 TEDDY LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LONETREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6798
Mailing Address - Country:US
Mailing Address - Phone:303-217-3735
Mailing Address - Fax:
Practice Address - Street 1:9224 TEDDY LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LONETREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6798
Practice Address - Country:US
Practice Address - Phone:303-217-3735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor