Provider Demographics
NPI:1902080864
Name:LEDBETTER, PAT J (MA, CMHT)
Entity Type:Individual
Prefix:MRS
First Name:PAT
Middle Name:J
Last Name:LEDBETTER
Suffix:
Gender:F
Credentials:MA, CMHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 HIGHWAY 7 S
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5392
Mailing Address - Country:US
Mailing Address - Phone:662-234-7521
Mailing Address - Fax:662-236-3071
Practice Address - Street 1:235 S. MURPHREE ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:MS
Practice Address - Zip Code:38951
Practice Address - Country:US
Practice Address - Phone:662-412-3251
Practice Address - Fax:662-412-3253
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSCH0804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018202Medicaid