Individual
DR. JONATHAN MICHAEL RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
4801 TROUP HWY STE 502, TYLER, TX 75703-2357
(903) 630-5788
(903) 630-5885
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
34806
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
34806
TEXAS LICENSE
—
Enumeration date
06/22/2010
Last updated
09/18/2023
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