Provider Demographics
NPI:1144920018
Name:RIOS, PRISCILLA (AMFT)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:RIOS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11054 VENTURA BLVD # 144
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3546
Mailing Address - Country:US
Mailing Address - Phone:310-487-1092
Mailing Address - Fax:
Practice Address - Street 1:8545 TUJUNGA VALLEY ST
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-3546
Practice Address - Country:US
Practice Address - Phone:310-487-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT136984106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist