Provider Demographics
NPI:1891073953
Name:RIVERA, JENNIFER L (MC, LPC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:L
Last Name:RIVERA
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2702
Mailing Address - Street 2:
Mailing Address - City:SNOWFLAKE
Mailing Address - State:AZ
Mailing Address - Zip Code:85937-2702
Mailing Address - Country:US
Mailing Address - Phone:480-250-5995
Mailing Address - Fax:
Practice Address - Street 1:91 S MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:SNOWFLAKE
Practice Address - State:AZ
Practice Address - Zip Code:85937-5285
Practice Address - Country:US
Practice Address - Phone:928-275-3015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12617101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional