Provider Demographics
NPI:1740921964
Name:RILEY, IAN K (LPC)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:K
Last Name:RILEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17203 NW MILITARY HWY APT 1207
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-9740
Mailing Address - Country:US
Mailing Address - Phone:856-796-2521
Mailing Address - Fax:
Practice Address - Street 1:16170 JONES MALTSBERGER RD STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3202
Practice Address - Country:US
Practice Address - Phone:210-396-1944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-03
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional