Provider Demographics
NPI:1508896101
Name:RIDINGER, DAVID NEALE (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:NEALE
Last Name:RIDINGER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-2413
Mailing Address - Country:US
Mailing Address - Phone:303-246-1760
Mailing Address - Fax:
Practice Address - Street 1:1400 SPENCER ST
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-2413
Practice Address - Country:US
Practice Address - Phone:303-246-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3795101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO673508OtherANTHEM BEHAVIORAL