Healthcare Provider Details

I. General information

NPI: 1730561325
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER RIVERA MA, LPC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 03/23/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 SAINT JOSEPH ST
ELTON LA
70532-3248
US

IV. Provider business mailing address

620 SAINT JOSEPH ST
ELTON LA
70532-3248
US

V. Phone/Fax

Practice location:
  • Phone: 337-853-1786
  • Fax:
Mailing address:
  • Phone: 337-853-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4734
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: