Provider Demographics
NPI:1689805178
Name:RIVERS, MARY (LPC AND LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LPC AND LMHC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:19120 SE 34TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-1430
Mailing Address - Country:US
Mailing Address - Phone:360-906-1190
Mailing Address - Fax:
Practice Address - Street 1:19120 SE 34TH ST STE 201
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1430
Practice Address - Country:US
Practice Address - Phone:360-906-1190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4052101Y00000X
OR11-06-62101YA0400X
ORR3301101YM0800X
WALH60659551101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR4052OtherLICENSED COUNSELOR IN OREGON LPC
WA60659551OtherLICENSED COUNSELOR IN WA
OR123190Medicaid