Provider Demographics
NPI:1881920213
Name:RIDENHOUR, RUTH EVELYN (LPC-CCDP-D)
Entity type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:EVELYN
Last Name:RIDENHOUR
Suffix:
Gender:F
Credentials:LPC-CCDP-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20005 HIGHWAY CC
Mailing Address - Street 2:
Mailing Address - City:LICKING
Mailing Address - State:MO
Mailing Address - Zip Code:65542-9139
Mailing Address - Country:US
Mailing Address - Phone:573-578-6479
Mailing Address - Fax:888-546-8711
Practice Address - Street 1:1205 HAUCK DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-4900
Practice Address - Country:US
Practice Address - Phone:573-578-6479
Practice Address - Fax:888-546-8711
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-20
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
8745101YA0400X
MO2009012867101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)