Provider Demographics
NPI:1316592512
Name:RIVERA, MELISSA CELESTINO (PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:CELESTINO
Last Name:RIVERA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TINNIN FORD RD APT 59
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-1606
Mailing Address - Country:US
Mailing Address - Phone:832-563-8799
Mailing Address - Fax:
Practice Address - Street 1:630 W 34TH ST STE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1217
Practice Address - Country:US
Practice Address - Phone:512-212-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142578363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health