Provider Demographics
NPI:1497965545
Name:RISSER, EDWARD (LPCC, NCC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RISSER
Suffix:
Gender:M
Credentials:LPCC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5629
Mailing Address - Country:US
Mailing Address - Phone:505-644-3299
Mailing Address - Fax:
Practice Address - Street 1:1225 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5629
Practice Address - Country:US
Practice Address - Phone:505-644-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2017-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0103691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health