Provider Demographics
NPI:1821411679
Name:RIVERS, JACQUELINE (LMFT)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:HATCH
Mailing Address - State:NM
Mailing Address - Zip Code:87937-0370
Mailing Address - Country:US
Mailing Address - Phone:575-267-3280
Mailing Address - Fax:575-267-1747
Practice Address - Street 1:1955 N VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-5154
Practice Address - Country:US
Practice Address - Phone:575-523-2772
Practice Address - Fax:575-524-2993
Is Sole Proprietor?:No
Enumeration Date:2014-01-30
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM165721106H00000X
NM0180001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22225072Medicaid