Provider Demographics
NPI:1861871618
Name:LEDBETTER, CAL D
Entity type:Individual
Prefix:
First Name:CAL
Middle Name:D
Last Name:LEDBETTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CAL
Other - Middle Name:D
Other - Last Name:LEDBETTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMHCA
Mailing Address - Street 1:4011 STONE WAY N B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-486-2965
Mailing Address - Fax:
Practice Address - Street 1:4011 STONE WAY N B
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-486-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60389085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health