Provider Demographics
NPI:1730566308
Name:RIEDO, ELENA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:RIEDO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 MARTIN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6247
Mailing Address - Country:US
Mailing Address - Phone:817-437-4505
Mailing Address - Fax:
Practice Address - Street 1:209 TRAVIS ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:TX
Practice Address - Zip Code:76262-8661
Practice Address - Country:US
Practice Address - Phone:817-437-4505
Practice Address - Fax:800-883-7014
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-02
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36929103TA0400X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral