Individual
KELLYE RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2204 PARK PLACE AVE STE B, FORT WORTH, TX 76110-1234
(682) 252-3830
Mailing address
2204 PARK PLACE AVE STE B, FORT WORTH, TX 76110-1234
(682) 252-3830
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
118027
TX
Other
Enumeration date
07/11/2026
Last updated
07/11/2026
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