Healthcare Provider Details

I. General information

NPI: 1649956830
Provider Name (Legal Business Name): ELISSA RIACH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7345 E US HIGHWAY 80
LONGVIEW TX
75605-6757
US

IV. Provider business mailing address

7109 JOHN MCCAIN RD
COLLEYVILLE TX
76034-6803
US

V. Phone/Fax

Practice location:
  • Phone: 903-668-2173
  • Fax:
Mailing address:
  • Phone: 817-781-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90011
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: