Provider Demographics
NPI:1477790855
Name:RIOS, YVONNE (LISAC)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:
Other - Last Name:RIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISAC
Mailing Address - Street 1:1811 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE160
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3001
Mailing Address - Country:US
Mailing Address - Phone:480-831-7566
Mailing Address - Fax:480-962-7671
Practice Address - Street 1:1811 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE160
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-3001
Practice Address - Country:US
Practice Address - Phone:480-831-7566
Practice Address - Fax:480-962-7671
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11795101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)