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Individual

DR. BLAKE ALEXANDER RIDDELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PSY.D.

Contact information

Practice address
600 SUNLAND PARK DR., BLDG. 6, SUITE 100, EL PASO, TX 79912-7991
(915) 584-3636
Mailing address
304 FOUNTAIN RD, EL PASO, TX 79912-3816
(817) 808-8053

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
37783
TX

Other

Enumeration date
04/11/2018
Last updated
04/11/2018
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