MEDICARE: JENNIFER RIVERA-ENRIQUEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	71724	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932616018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RIVERA-ENRIQUEZ LPC

Provider Business Mailing Address
First Line	:	1508 DESSAU RIDGE LN STE 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	512-585-0830
Fax Number	:

Provider Business Practice Location Address
First Line	:	1508 DESSAU RIDGE LN STE 204
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-2190
Country	:	US
Telephone Number	:	512-585-0830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2018
Last Update Date	:	05/13/2021

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