Provider Demographics
NPI:1063682458
Name:RIO VISTA COUNSELING
Entity type:Organization
Organization Name:RIO VISTA COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SPEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:505-507-4408
Mailing Address - Street 1:8417 WASHINGTON PL NE STE B
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1720
Mailing Address - Country:US
Mailing Address - Phone:505-507-4408
Mailing Address - Fax:
Practice Address - Street 1:8417 WASHINGTON PL NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-1720
Practice Address - Country:US
Practice Address - Phone:505-507-4408
Practice Address - Fax:505-867-6059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMVNM012413NOMedicaid
NMVNM012413PSMedicaid
NMVNM012413OTMedicaid
NMVNM012413NIMedicaid
NM1255457339Medicaid
NMVNM012413PXMedicaid
NM35473011Medicaid