Provider Demographics
NPI:1558463984
Name:RIDDELL, JOAN ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:ELIZABETH
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:BEATTY
Other - Last Name:RIDDELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:901 NE INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-5544
Mailing Address - Country:US
Mailing Address - Phone:816-347-3007
Mailing Address - Fax:816-246-8207
Practice Address - Street 1:901 NE INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-5544
Practice Address - Country:US
Practice Address - Phone:816-347-3007
Practice Address - Fax:816-246-8207
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002189101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional