Provider Demographics
NPI:1467659052
Name:LUDWIG, BETH ANNE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:ANNE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SHASTA
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2223
Mailing Address - Country:US
Mailing Address - Phone:949-413-2818
Mailing Address - Fax:
Practice Address - Street 1:2055 KELLOGG AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3111
Practice Address - Country:US
Practice Address - Phone:951-898-7208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24532106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist