Provider Demographics
NPI:1518282961
Name:HUDSON, KAREN DENISE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DENISE
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5713 EUGENE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-6206
Mailing Address - Country:US
Mailing Address - Phone:702-647-0252
Mailing Address - Fax:702-647-0252
Practice Address - Street 1:5713 EUGENE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6206
Practice Address - Country:US
Practice Address - Phone:702-647-0252
Practice Address - Fax:702-647-0252
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3577HIC-8103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities