Provider Demographics
NPI:1710358684
Name:RIDEG, AMY (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:RIDEG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5266 HOLLISTER AVE STE 332
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2084
Mailing Address - Country:US
Mailing Address - Phone:805-288-0981
Mailing Address - Fax:
Practice Address - Street 1:5266 HOLLISTER AVE STE 332
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2084
Practice Address - Country:US
Practice Address - Phone:805-288-0981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist