Provider Demographics
NPI:1811015647
Name:RIVAS, MIRIAM V (LPCC, LPC)
Entity Type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:V
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LPCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 KINGSPOINT DR APT 54
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6506
Mailing Address - Country:US
Mailing Address - Phone:915-203-5103
Mailing Address - Fax:
Practice Address - Street 1:4950 MCNUTT RD.
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88021
Practice Address - Country:US
Practice Address - Phone:915-203-5103
Practice Address - Fax:915-351-6601
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0110021101YM0800X
NM0128131101YP2500X
TX66211101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM600035OtherNM MEDICAID