1396992509 NPI number — MR. DAVID EARL RIDLEY SC.D., LMHC

Table of content: MR. DAVID EARL RIDLEY SC.D., LMHC (NPI 1396992509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396992509 NPI number — MR. DAVID EARL RIDLEY SC.D., LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDLEY
Provider First Name:
DAVID
Provider Middle Name:
EARL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
SC.D., LMHC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396992509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1787 HALEOKEA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HILO
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96720-5946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-959-5911
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
52 WAIANUENUE AVE
Provider Second Line Business Practice Location Address:
ROOM 202
Provider Business Practice Location Address City Name:
HILO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-935-4412
Provider Business Practice Location Address Fax Number:
808-969-9447
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LMH 100 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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