Basic Information
| Provider Information | |||||||||
| NPI: | 1902896673 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LADUE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2231 CAMINO DEL RIO S | ||||||||
| Address2: | STE 308 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192972571 | ||||||||
| FaxNumber: | 6192603054 | ||||||||
| Practice Location | |||||||||
| Address1: | 2231 CAMINO DEL RIO S | ||||||||
| Address2: | STE 308 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921083612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192972571 | ||||||||
| FaxNumber: | 6192603054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT32073 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.