Provider Demographics
NPI:1306616636
Name:RIVAS, JENESSA LOUISE (LPC-A)
Entity type:Individual
Prefix:
First Name:JENESSA
Middle Name:LOUISE
Last Name:RIVAS
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6606 FM 1488 RD STE 148-660
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2544
Mailing Address - Country:US
Mailing Address - Phone:281-789-8677
Mailing Address - Fax:
Practice Address - Street 1:33130 MAGNOLIA CIR STE A21
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3277
Practice Address - Country:US
Practice Address - Phone:281-789-8677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93411101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional