MEDICARE: ELIZABETH RIDL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LAC23440	AZ

General Provider Information

NPI Number	:	1023964236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH RIDL

Provider Business Mailing Address
First Line	:	67 S HIGLEY RD
Second Line	:	103-456
City	:	GILBERT
State	:	AZ
Zip	:	85296
Country	:	US
Telephone Number	:	928-228-5431
Fax Number	:

Provider Business Practice Location Address
First Line	:	67 S HIGLEY RD
Second Line	:	103-456
City	:	GILBERT
State	:	AZ
Zip	:	85296
Country	:	US
Telephone Number	:	928-228-5431
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ ELIZABETH RIDL ” Practice Location

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