MEDICARE: DR. BITA ASHOURI RIVAS ED.D, LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	101YM0800X	Mental Health Counselor
3	101YP2500X	Professional Counselor
4	101YP2500X	Professional Counselor	11298	CO

General Provider Information

NPI Number	:	1144531054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BITA ASHOURI RIVAS ED.D, LPC, NCC

Provider Business Mailing Address
First Line	:	2163 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	303-217-3732
Fax Number	:	719-418-2770

Provider Business Practice Location Address
First Line	:	2163 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1507
Country	:	US
Telephone Number	:	303-217-3732
Fax Number	:	719-418-2770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2010
Last Update Date	:	09/15/2014

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