Provider Demographics
NPI:1306555370
Name:RIVERA, GERARDO JR (MA, LCCA, LPC)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:RIVERA
Suffix:JR
Gender:M
Credentials:MA, LCCA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4222 COPPER CRK
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3084
Mailing Address - Country:US
Mailing Address - Phone:346-710-5557
Mailing Address - Fax:
Practice Address - Street 1:4222 COPPER CRK
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3084
Practice Address - Country:US
Practice Address - Phone:346-710-5557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78580101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor