Provider Demographics
NPI:1821017302
Name:REDDICK, LAURA T (MFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:T
Last Name:REDDICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 G ST STE C3
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-4447
Mailing Address - Country:US
Mailing Address - Phone:707-442-2459
Mailing Address - Fax:707-442-2459
Practice Address - Street 1:2830 G ST STE C3
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-442-2459
Practice Address - Fax:707-442-2459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA202422298OtherEIN