Provider Demographics
NPI:1346898442
Name:RIDDLE, AMANDA MICHELE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:MICHELE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MICHELE
Other - Last Name:COLLIATIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:6611 E CENTRAL AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1937
Mailing Address - Country:US
Mailing Address - Phone:316-393-2447
Mailing Address - Fax:
Practice Address - Street 1:3595 E FOUNTAIN BLVD STE 130
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-1734
Practice Address - Country:US
Practice Address - Phone:719-839-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-01
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3074106H00000X
COMFT.0002097106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist