Provider Demographics
NPI:1255822664
Name:LEDBETTER, DAVID (MA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W WILSON RD
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-4505
Mailing Address - Country:US
Mailing Address - Phone:626-384-8363
Mailing Address - Fax:
Practice Address - Street 1:2280 E CALVADA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-5877
Practice Address - Country:US
Practice Address - Phone:775-751-5211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional