Healthcare Provider Details

I. General information

NPI: 1114485984
Provider Name (Legal Business Name): STORM RIVAS LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2019
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 BELKNAP PL
SAN ANTONIO TX
78212-3413
US

IV. Provider business mailing address

605 BELKNAP PL
SAN ANTONIO TX
78212-3413
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-1212
  • Fax:
Mailing address:
  • Phone: 210-737-1212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86854
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: