Provider Demographics
NPI:1568233567
Name:HUDSON YILDIRIM, LAKISHA CHANTEL (LCPC, CRC)
Entity Type:Individual
Prefix:DR
First Name:LAKISHA
Middle Name:CHANTEL
Last Name:HUDSON YILDIRIM
Suffix:
Gender:F
Credentials:LCPC, CRC
Other - Prefix:DR
Other - First Name:LAKISHA
Other - Middle Name:CHANTEL
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC, CRC
Mailing Address - Street 1:PSC 79 BOX 98
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09714-0001
Mailing Address - Country:US
Mailing Address - Phone:423-437-5454
Mailing Address - Fax:
Practice Address - Street 1:1603 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WA
Practice Address - Zip Code:82001
Practice Address - Country:US
Practice Address - Phone:423-437-5454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.014300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health