Provider Demographics
NPI:1508101015
Name:HUDSON, MICHAEL ROSS (LCDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROSS
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 FM 1765 BLDG 1
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-3672
Mailing Address - Country:US
Mailing Address - Phone:409-944-4399
Mailing Address - Fax:
Practice Address - Street 1:7510 FM 1765 BLDG 1
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-3672
Practice Address - Country:US
Practice Address - Phone:409-944-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10478101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)