Provider Demographics
NPI:1659049815
Name:RIVERA, DESIREE (MS, AMFT)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MS, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22853
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2853
Mailing Address - Country:US
Mailing Address - Phone:442-500-8548
Mailing Address - Fax:760-400-8379
Practice Address - Street 1:2103 S EL CAMINO REAL STE 206
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6281
Practice Address - Country:US
Practice Address - Phone:442-500-8548
Practice Address - Fax:760-400-8379
Is Sole Proprietor?:No
Enumeration Date:2021-09-02
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6910101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health