Provider Demographics
NPI:1841814217
Name:RIVERA, ALLEN (MA LPC)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:RIVERA
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 1:300 N I 35
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-5226
Mailing Address - Country:US
Mailing Address - Phone:214-530-0021
Mailing Address - Fax:214-530-0021
Practice Address - Street 1:540 SILICON DR STE 103
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7507
Practice Address - Country:US
Practice Address - Phone:214-530-0021
Practice Address - Fax:214-530-0021
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional