Provider Demographics
NPI:1891982500
Name:RIVERA, VICTOR XAVIER (MED, MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:XAVIER
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MED, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MOPAC CIRCLE
Mailing Address - Street 2:102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-732-2120
Mailing Address - Fax:512-458-4569
Practice Address - Street 1:1007 MOPAC CIRCLE
Practice Address - Street 2:102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-732-2120
Practice Address - Fax:512-458-4569
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health