Healthcare Provider Details

I. General information

NPI: 1750803003
Provider Name (Legal Business Name): PEDRO F RIDDELL MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N CHELTON RD STE 210
COLORADO SPRINGS CO
80909-5256
US

IV. Provider business mailing address

5962 MUMFORD DR
COLORADO SPRINGS CO
80925-8473
US

V. Phone/Fax

Practice location:
  • Phone: 719-500-6009
  • Fax: 719-890-7162
Mailing address:
  • Phone: 719-500-6009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: