Provider Demographics
NPI:1023526308
Name:RIDDLE, AUBREY (LCSW)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 COLERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6300
Mailing Address - Country:US
Mailing Address - Phone:801-390-7192
Mailing Address - Fax:
Practice Address - Street 1:2315 COLERIDGE CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6300
Practice Address - Country:US
Practice Address - Phone:801-390-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-20
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX599831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical