Provider Demographics
NPI:1972357309
Name:REDDINGER, BETHANY ROSE (AMFT)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:ROSE
Last Name:REDDINGER
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 CALLE LAS CASAS
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6536
Mailing Address - Country:US
Mailing Address - Phone:315-657-7141
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ STE 251
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2642
Practice Address - Country:US
Practice Address - Phone:760-576-4311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT145880106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist