Healthcare Provider Details

I. General information

NPI: 1023964236
Provider Name (Legal Business Name): ELIZABETH RIDL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 S HIGLEY RD 103-456
GILBERT AZ
85296
US

IV. Provider business mailing address

67 S HIGLEY RD 103-456
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 928-228-5431
  • Fax:
Mailing address:
  • Phone: 928-228-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC23440
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: