Individual
JOSE GUILLERMO RIVAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PPC
Contact information
Practice address
140 E BROADWAY AVE # B-13, JACKSON, WY 83001-8632
(307) 413-6528
Mailing address
140 E BROADWAY AVE # B-13, JACKSON, WY 83001-8632
(307) 413-6528
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PPC-1076
WY
Other
Enumeration date
07/26/2018
Last updated
07/26/2018
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