Provider Demographics
NPI:1962536490
Name:RIVAS, GILBERTO (LMFT)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:RIVAS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 E ASHLAN AVE STE 118
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-3021
Mailing Address - Country:US
Mailing Address - Phone:559-256-4474
Mailing Address - Fax:
Practice Address - Street 1:4910 E ASHLAN AVE STE 118
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-3021
Practice Address - Country:US
Practice Address - Phone:559-256-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50073106H00000X
CALMFT 50073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT 50073OtherBBS