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General NPI Number Information
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NPI Number | 1790328987
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Entity Type | Individual
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Provider Name | ESTEBAN RIVERA
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Gender | Male
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 7 HERITAGE OAK LN STE 1
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City | BATTLE CREEK
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State | MI
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Zip | 49015-4283
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Country | US
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Telephone | 269-968-2811
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Fax | 269-968-2651
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Provider Business Mailing Address
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Address Line | 226 S 21ST ST
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City | BATTLE CREEK
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State | MI
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Zip | 49015-3006
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Country | US
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Telephone | 269-964-4713
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401017737
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License Number State | MI
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