Provider Demographics
NPI:1306656871
Name:REDDY, ALICEA ANN LEDBETTER (AMFT)
Entity type:Individual
Prefix:
First Name:ALICEA
Middle Name:ANN LEDBETTER
Last Name:REDDY
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2548
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96158-4048
Mailing Address - Country:US
Mailing Address - Phone:530-350-5150
Mailing Address - Fax:
Practice Address - Street 1:3079 HARRISON AVE STE 25
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7978
Practice Address - Country:US
Practice Address - Phone:530-350-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT151573106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist