Provider Demographics
NPI:1861896045
Name:MICHELLE RIDENOUR, LMHC, PSC
Entity type:Organization
Organization Name:MICHELLE RIDENOUR, LMHC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:765-978-0236
Mailing Address - Street 1:6629 S COUNTY ROAD 400 E
Mailing Address - Street 2:
Mailing Address - City:KIRKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46050-9666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1202 S JACKSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-3390
Practice Address - Country:US
Practice Address - Phone:765-978-0236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-16
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002388A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty