Individual
RANDALL J. RIDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LSW, LMFT
Contact information
Practice address
4235 FLAGSTAFF COVE, FORT WAYNE, IN 46815-4418
(260) 969-6600
Mailing address
3535 MAXIM DR, FORT WAYNE, IN 46815-6130
(260) 312-0904
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
35000981A
IN
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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