Provider Demographics
NPI:1043488950
Name:RIEDELL, COLLEEN RUTH (MFT)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:RUTH
Last Name:RIEDELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 NAUTICAL WAY
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6762
Mailing Address - Country:US
Mailing Address - Phone:805-289-0120
Mailing Address - Fax:
Practice Address - Street 1:1838 EASTMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6496
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF41426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherSHORT DOYLE PROVIDER