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General NPI Number Information
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NPI Number | 1952186694
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Entity Type | Individual
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Provider Name | TREMAINE DANTE LEDBETTER
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Gender | Male
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Dates
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Enumeration Date | 08/30/2023
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 14014 PARK AVE
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City | DOLTON
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State | IL
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Zip | 60419-1029
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Country | US
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Telephone | 708-880-1387
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 MOSS ST APT 2
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City | HAMMOND
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State | IN
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Zip | 46320-2728
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Country | US
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Telephone | 708-248-0180
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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