Provider Demographics
NPI:1699769737
Name:RIVERS, GLENDA SUSAN (LMFT)
Entity type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:SUSAN
Last Name:RIVERS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:GLENDA
Other - Middle Name:SUSAN
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CMFT
Mailing Address - Street 1:345 S TRONTERA CIR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4812
Mailing Address - Country:US
Mailing Address - Phone:623-935-4474
Mailing Address - Fax:
Practice Address - Street 1:14122 W MCDOWELL RD
Practice Address - Street 2:SUITE 103 C
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-2503
Practice Address - Country:US
Practice Address - Phone:623-935-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT 0128101YM0800X
CAMFC 28,156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health