Basic Information
| Provider Information | |||||||||
| NPI: | 1336610724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIVERA | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | ISABEL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9815 HALLMARK LN | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775843124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326659590 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2552 BROADWAY ST STE 102 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775814904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2818241480 | ||||||||
| FaxNumber: | 2812206407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 01/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 77667 | TX | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | 77667 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.