Provider Demographics
NPI:1225283039
Name:HUGHES, JODY L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:L
Last Name:HUGHES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S. MICHIGAN STREET
Mailing Address - Street 2:SUITE 875
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601
Mailing Address - Country:US
Mailing Address - Phone:574-855-7730
Mailing Address - Fax:574-988-0167
Practice Address - Street 1:202 S. MICHIGAN STREET
Practice Address - Street 2:SUITE 875
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601
Practice Address - Country:US
Practice Address - Phone:574-855-7730
Practice Address - Fax:574-988-0167
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN34005886A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11490425OtherCAQH