Provider Demographics
NPI:1689099624
Name:RIVERA, MELISSA (LPC, BCBA)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:THIBODAUX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, BCBA
Mailing Address - Street 1:1617 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3976
Mailing Address - Country:US
Mailing Address - Phone:504-494-1461
Mailing Address - Fax:
Practice Address - Street 1:512 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4308
Practice Address - Country:US
Practice Address - Phone:504-494-1461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2761101YP2500X
LAL-050103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional