Provider Demographics
NPI:1255728127
Name:RILEY, BERNIS (PSYD,, LPC-S)
Entity type:Individual
Prefix:DR
First Name:BERNIS
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:PSYD,, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6316 TOSCA DR
Mailing Address - Street 2:
Mailing Address - City:HALTOM CITY
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8028
Mailing Address - Country:US
Mailing Address - Phone:817-808-2606
Mailing Address - Fax:
Practice Address - Street 1:405 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-4151
Practice Address - Country:US
Practice Address - Phone:817-808-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional