Provider Demographics
NPI:1477913226
Name:HUDGINS, KIELA RAE (MSE, PLMHP)
Entity Type:Individual
Prefix:MRS
First Name:KIELA
Middle Name:RAE
Last Name:HUDGINS
Suffix:
Gender:F
Credentials:MSE, PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13435 A ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3658
Mailing Address - Country:US
Mailing Address - Phone:402-697-3923
Mailing Address - Fax:402-697-3924
Practice Address - Street 1:13435 A ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3658
Practice Address - Country:US
Practice Address - Phone:402-697-3923
Practice Address - Fax:402-697-3924
Is Sole Proprietor?:No
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health