Provider Demographics
NPI:1295336931
Name:RIVERA, ANGELICA ROSE (LPC-INTERN)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ROSE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 HIGHWAY 6 STE 255
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4917
Mailing Address - Country:US
Mailing Address - Phone:281-769-2238
Mailing Address - Fax:
Practice Address - Street 1:1111 HIGHWAY 6 STE 255
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4917
Practice Address - Country:US
Practice Address - Phone:281-769-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health