Provider Demographics
NPI:1437241023
Name:HUDSPETH, EDWARD (RPH, LPC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:HUDSPETH
Suffix:
Gender:M
Credentials:RPH, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2058 ROBISON RD
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-4056
Mailing Address - Country:US
Mailing Address - Phone:888-266-7044
Mailing Address - Fax:502-385-6539
Practice Address - Street 1:2058 ROBISON RD
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-4056
Practice Address - Country:US
Practice Address - Phone:888-266-7044
Practice Address - Fax:502-385-6539
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE07896183500000X
ARPD07685183500000X
MS1108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No183500000XPharmacy Service ProvidersPharmacist