Provider Demographics
NPI:1871334615
Name:RIVERA, KARLA MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:MARIE
Last Name:RIVERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6248 W NEWPORT AVE # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4143
Mailing Address - Country:US
Mailing Address - Phone:773-682-5697
Mailing Address - Fax:
Practice Address - Street 1:3976 N AVONDALE AVE FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-2900
Practice Address - Country:US
Practice Address - Phone:312-319-4162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020251101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional