Individual
MR. BRADLEY JOE RIDENOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
509 S JEFFERSON AVE, AURORA, MO 65605-2213
(417) 678-0403
Mailing address
906 S ROSEWOOD DR, MONETT, MO 65708-1235
(417) 235-0741
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2002010860
MO
Other
Enumeration date
12/29/2006
Last updated
07/08/2007
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