Provider Demographics
NPI:1447578612
Name:RIDDICK, MEREDITH (LPC-S, CEDS-S)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:LPC-S, CEDS-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 PARK GROVE LN STE 720
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-1577
Mailing Address - Country:US
Mailing Address - Phone:713-301-5750
Mailing Address - Fax:
Practice Address - Street 1:411 PARK GROVE LN STE 720
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-1577
Practice Address - Country:US
Practice Address - Phone:713-301-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65831101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional