Provider Demographics
NPI:1871913590
Name:RIOS, LOURDES ELVIRA (LMHC)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:ELVIRA
Last Name:RIOS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20740 SW 79TH PL
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-3433
Mailing Address - Country:US
Mailing Address - Phone:305-807-3081
Mailing Address - Fax:
Practice Address - Street 1:20740 SW 79TH PL
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-3433
Practice Address - Country:US
Practice Address - Phone:305-807-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12183101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health