Provider Demographics
NPI:1659491611
Name:RIVERA-HO, SHAWN M (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:RIVERA-HO
Suffix:
Gender:F
Credentials:MS, LMFT
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 14068
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-4068
Mailing Address - Country:US
Mailing Address - Phone:714-814-3462
Mailing Address - Fax:
Practice Address - Street 1:17332 IRVINE BLVD STE 234
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3063
Practice Address - Country:US
Practice Address - Phone:714-814-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40376106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist