Individual
MRS. TELLY E RIVENBURGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4864 E BASELINE RD, MESA, AZ 85206-4629
(480) 200-7371
Mailing address
460 N MESA DR STE 101, MESA, AZ 85201-5949
(480) 200-7371
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW23412
AZ
Other
Enumeration date
11/13/2025
Last updated
11/13/2025
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