Healthcare Provider Details

I. General information

NPI: 1144187915
Provider Name (Legal Business Name): COLLEEN MARIE RIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2563 S VAL VISTA DR STE 108
GILBERT AZ
85295-6231
US

IV. Provider business mailing address

2563 S VAL VISTA DR STE 108
GILBERT AZ
85295-6231
US

V. Phone/Fax

Practice location:
  • Phone: 480-448-1076
  • Fax:
Mailing address:
  • Phone: 480-448-1076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: