Provider Demographics
NPI:1972036986
Name:RIVARD, DYLAN JAMES (MA, LPC)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:RIVARD
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11648 RANCH ELSIE RD
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7307
Mailing Address - Country:US
Mailing Address - Phone:720-633-4311
Mailing Address - Fax:
Practice Address - Street 1:100 ARAPAHOE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5854
Practice Address - Country:US
Practice Address - Phone:720-633-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional