Provider Demographics
NPI:1508649674
Name:RIVAS, LORRAINE RUTH (LAC, MSW)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:RUTH
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LAC, MSW
Other - Prefix:
Other - First Name:RANI
Other - Middle Name:R
Other - Last Name:RIVAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, MSW
Mailing Address - Street 1:2320 E MACARTHUR RD LOT M8
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67216-2676
Mailing Address - Country:US
Mailing Address - Phone:316-207-5445
Mailing Address - Fax:
Practice Address - Street 1:3737 W DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-2407
Practice Address - Country:US
Practice Address - Phone:316-941-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)