Organization
JONATHAN RIDENOUR, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE BICE (OFFICE MANAGER)
(903) 630-5788
Entity
Organization
Contact information
Practice address
4801 TROUP HWY STE 502, TYLER, TX 75703-2357
(972) 424-9212
(972) 509-1450
Mailing address
4801 TROUP HWY STE 502, TYLER, TX 75703-2357
(903) 630-5788
(903) 630-5885
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
03/11/2019
Last updated
09/18/2023
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