Provider Demographics
NPI:1588037774
Name:RIVENLOCH, KYRA S (LCSW)
Entity type:Individual
Prefix:
First Name:KYRA
Middle Name:S
Last Name:RIVENLOCH
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:KYRA
Other - Middle Name:M
Other - Last Name:LOGSDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 40305
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-0305
Mailing Address - Country:US
Mailing Address - Phone:970-208-2682
Mailing Address - Fax:
Practice Address - Street 1:3057 HILL AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-2607
Practice Address - Country:US
Practice Address - Phone:970-208-2682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-10
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0105944101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health