Healthcare Provider Details

I. General information

NPI: 1063682458
Provider Name (Legal Business Name): RIO VISTA COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8417 WASHINGTON PL NE STE B
ALBUQUERQUE NM
87113-1720
US

IV. Provider business mailing address

8417 WASHINGTON PL NE STE B
ALBUQUERQUE NM
87113-1720
US

V. Phone/Fax

Practice location:
  • Phone: 505-507-4408
  • Fax: 505-867-6059
Mailing address:
  • Phone: 505-507-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH SUSAN SPEAKER
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LPCC
Phone: 505-507-4408