Provider Demographics
NPI:1962653337
Name:RILES, VINCENT A (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:A
Last Name:RILES
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 BENDING OAK DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-5527
Mailing Address - Country:US
Mailing Address - Phone:214-498-0304
Mailing Address - Fax:
Practice Address - Street 1:4111 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-8456
Practice Address - Country:US
Practice Address - Phone:214-498-0304
Practice Address - Fax:214-339-5155
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-03
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional