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General NPI Number Information
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NPI Number | 1811015647
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Entity Type | Individual
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Provider Name | MIRIAM V RIVAS LPCC, LPC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 5305 MCNUTT RD STE E
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City | SANTA TERESA
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State | NM
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Zip | 88008-9685
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Country | US
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Telephone | 915-203-5103
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Fax | 915-351-6601
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Provider Business Mailing Address
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Address Line | 5290 MCNUTT RD STE. 211 #1137
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City | SANTA TERESA
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State | NM
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Zip | 88008-9694
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Country | US
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Telephone | 915-203-5103
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0110021
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 66211
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0128131
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License Number State | NM
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