Provider Demographics
NPI:1508625393
Name:RIVERA, JOMARIO (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:JOMARIO
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 MORELOS AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO VIEJO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9516
Mailing Address - Country:US
Mailing Address - Phone:956-266-1266
Mailing Address - Fax:
Practice Address - Street 1:204 MORELOS AVE
Practice Address - Street 2:
Practice Address - City:RANCHO VIEJO
Practice Address - State:TX
Practice Address - Zip Code:78575-9516
Practice Address - Country:US
Practice Address - Phone:956-266-1266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90407101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty