Provider Demographics
NPI:1417164922
Name:RIDGE, SEAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:M
Last Name:RIDGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 JOHNSON DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37998-0001
Mailing Address - Country:US
Mailing Address - Phone:865-250-7966
Mailing Address - Fax:
Practice Address - Street 1:7900 JOHNSON DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37998-0001
Practice Address - Country:US
Practice Address - Phone:865-250-7966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0500021106H00000X
TNLMT758106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist