Provider Demographics
NPI:1629784319
Name:RIDDLE, BRITTANY (MAMFT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:MAMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8009 NEW LA GRANGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4791
Mailing Address - Country:US
Mailing Address - Phone:502-509-9307
Mailing Address - Fax:
Practice Address - Street 1:8009 NEW LA GRANGE RD STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4791
Practice Address - Country:US
Practice Address - Phone:502-509-9307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist