Provider Demographics
NPI:1609241751
Name:RIVERA, KURTIS JAMES (MA, CAC II)
Entity type:Individual
Prefix:MR
First Name:KURTIS
Middle Name:JAMES
Last Name:RIVERA
Suffix:
Gender:M
Credentials:MA, CAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W CORONA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-1210
Mailing Address - Country:US
Mailing Address - Phone:719-299-0824
Mailing Address - Fax:
Practice Address - Street 1:635 W CORONA AVE STE 200
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1210
Practice Address - Country:US
Practice Address - Phone:719-299-0824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0022453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health