Provider Demographics
NPI:1063765501
Name:RIVERA, MIGUEL ANGEL (LMHC)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ANGEL
Last Name:RIVERA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PALM COAST RESORT BLVD
Mailing Address - Street 2:UNIT #704
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-1812
Mailing Address - Country:US
Mailing Address - Phone:386-864-0505
Mailing Address - Fax:
Practice Address - Street 1:146 PALM COAST RESORT BLVD
Practice Address - Street 2:UNIT #704
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-1812
Practice Address - Country:US
Practice Address - Phone:386-864-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health