Provider Demographics
NPI:1417496639
Name:HUDSON, GERAMY (MA, LMHCA)
Entity Type:Individual
Prefix:MR
First Name:GERAMY
Middle Name:
Last Name:HUDSON
Suffix:
Gender:M
Credentials:MA, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14233 AMBAUM BLVD SW
Mailing Address - Street 2:# R
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1421
Mailing Address - Country:US
Mailing Address - Phone:206-485-4012
Mailing Address - Fax:
Practice Address - Street 1:14233 AMBAUM BLVD SW
Practice Address - Street 2:# R
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1421
Practice Address - Country:US
Practice Address - Phone:206-485-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC 60332713101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health