Provider Demographics
NPI:1558562504
Name:RIEDEL, MATHA KATHERINE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MATHA
Middle Name:KATHERINE
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 RIDGEGATE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5615
Mailing Address - Country:US
Mailing Address - Phone:817-825-4829
Mailing Address - Fax:817-581-0344
Practice Address - Street 1:401 RIDGEGATE DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5615
Practice Address - Country:US
Practice Address - Phone:817-825-4829
Practice Address - Fax:817-581-0344
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional