Provider Demographics
NPI:1225844525
Name:MICHAEL C RIVERA LPC
Entity type:Organization
Organization Name:MICHAEL C RIVERA LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-A
Authorized Official - Phone:337-853-1786
Mailing Address - Street 1:620 SAINT JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:ELTON
Mailing Address - State:LA
Mailing Address - Zip Code:70532-3248
Mailing Address - Country:US
Mailing Address - Phone:337-853-1786
Mailing Address - Fax:
Practice Address - Street 1:620 SAINT JOSEPH ST
Practice Address - Street 2:
Practice Address - City:ELTON
Practice Address - State:LA
Practice Address - Zip Code:70532-3248
Practice Address - Country:US
Practice Address - Phone:337-853-1786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2025-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6915724Medicaid