Basic Information
| Provider Information | |||||||||
| NPI: | 1114485984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVAS | ||||||||
| FirstName: | STORM | ||||||||
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| Credential: | LPC-ASSOCIATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1919 NW LOOP 410 STE 201 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782132325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2107337117 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11306 SIR WINSTON ST BLDG F | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162467 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2103660049 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2019 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 101YP2500X | 86854 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.