Provider Demographics
NPI:1083834121
Name:LUDINGTON, ALAN (MDIV, MS)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:LUDINGTON
Suffix:
Gender:M
Credentials:MDIV, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 PRESILLA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8226
Mailing Address - Country:US
Mailing Address - Phone:805-523-0445
Mailing Address - Fax:805-449-4376
Practice Address - Street 1:875 S WESTLAKE BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2902
Practice Address - Country:US
Practice Address - Phone:805-494-8864
Practice Address - Fax:805-449-4376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist