Provider Demographics
NPI:1518262179
Name:RIOS, DAVID STRAIT (LCSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:STRAIT
Last Name:RIOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3561 SUN MESA ST SW
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6164
Mailing Address - Country:US
Mailing Address - Phone:505-410-3403
Mailing Address - Fax:
Practice Address - Street 1:401 ACOMA ST STE 105
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-5268
Practice Address - Country:US
Practice Address - Phone:505-410-3403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-053411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical