Provider Demographics
NPI:1902896673
Name:LADUE, GREGORY (MFT)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:LADUE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 CAMINO DEL RIO S
Mailing Address - Street 2:STE 308
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3612
Mailing Address - Country:US
Mailing Address - Phone:619-297-2571
Mailing Address - Fax:619-260-3054
Practice Address - Street 1:2231 CAMINO DEL RIO S
Practice Address - Street 2:STE 308
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3612
Practice Address - Country:US
Practice Address - Phone:619-297-2571
Practice Address - Fax:619-260-3054
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT32073106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist