Provider Demographics
NPI:1396941571
Name:RIDLEY, DAVID H (MFTI)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:H
Last Name:RIDLEY
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 HOOPES AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6106
Mailing Address - Country:US
Mailing Address - Phone:208-557-9724
Mailing Address - Fax:208-524-1701
Practice Address - Street 1:611 HOOPES AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6106
Practice Address - Country:US
Practice Address - Phone:208-557-9724
Practice Address - Fax:208-524-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist