MEDICARE: MR. ANDRES IVAN RIVAS LGPC

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	101YM0800X	Mental Health Counselor	LGP17433	MD

General Provider Information

NPI Number	:	1225995434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDRES IVAN RIVAS LGPC

Provider Business Mailing Address
First Line	:	10 STAGS LEAP CT
Second Line	:
City	:	GERMANTOWN
State	:	MD
Zip	:	20874-6326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 BLACKBURN LN STE 110
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-6134
Country	:	US
Telephone Number	:	240-451-2171
Fax Number	:	240-366-2131

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

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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