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NPI Code Detail

MEDICARE: MR. SHON M RIDENOUR

MEDICARE: MR. SHON M RIDENOUR
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
1101YM0800XMental Health Counselor
2101YM0800XMental Health Counselor39005131AIN

General Provider Information

NPI Number : 1528689825
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SHON M RIDENOUR
Provider Business Mailing Address
First Line : 3295 PAISLEY POINTE
Second Line :
City : WHITESTOWN
State : IN
Zip : 46075-9778
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5610 CRAWFORDSVILLE RD STE 2201
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46224-3784
Country : US
Telephone Number : 317-244-2792
Fax Number : 317-243-2328
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2020
Last Update Date : 01/13/2025

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Directions to “ MR. SHON M RIDENOUR ” Practice Location

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