Individual
LAURA LYNN RIVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 WILSON CIR, BOULDER CITY, NV 89005
(702) 294-7100
Mailing address
200 WILSON CIR, BOULDER CITY, NV 89005-4401
(702) 294-7100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710222815
—
CA
Enumeration date
11/30/2012
Last updated
08/31/2018
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