Provider Demographics
NPI:1801251590
Name:RIEDEL, SUZANNE MAITLAND (MS, LMFT)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAITLAND
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-0192
Mailing Address - Country:US
Mailing Address - Phone:657-204-6495
Mailing Address - Fax:
Practice Address - Street 1:369 S GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-1919
Practice Address - Country:US
Practice Address - Phone:657-204-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist