| Doctor Name: | LISA RIVERA |
| NPI Number: | 1033581749 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, LPC, LAC |
| License Number: | ACD0000527 |
| Business Practice Address: | 1225 Ken Pratt Blvd Ste. 200 Longmont, CO - 805016518 |
| Business Phone Number: | 3037723382 |
| Business Fax Number: | |
| Mailing Address: | 1225 Ken Pratt Blvd, Ste. 200 LONGMONT |
| State: | CO |
| Postal Code: | 805016518 |
| Phone Number: | 3037723382 |
| Fax Number: | |
| NPI Enumeration Date: | 10/21/2015 |
| NPI Last Update Date: | 10/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | ACD0000527 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |