Provider Demographics
NPI:1275784829
Name:RIVON, MISTY (LCSW)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:RIVON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4304 ALCONBURY LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-1632
Mailing Address - Country:US
Mailing Address - Phone:214-495-8975
Mailing Address - Fax:
Practice Address - Street 1:1206 BRADFORD TRACE DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-0928
Practice Address - Country:US
Practice Address - Phone:214-495-8975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX402151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical