Provider Demographics
NPI:1578670857
Name:HUDSON, PEGGY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:A
Last Name:HUDSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 NE 13TH ST # 116A
Mailing Address - Street 2:OKLAHOMA CITY VA MEDICAL CENTER
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-5007
Mailing Address - Country:US
Mailing Address - Phone:405-456-5183
Mailing Address - Fax:405-456-1523
Practice Address - Street 1:921 NE 13TH ST # 116A
Practice Address - Street 2:OKLAHOMA CITY VA MEDICAL CENTER
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-5007
Practice Address - Country:US
Practice Address - Phone:405-456-5183
Practice Address - Fax:405-456-1523
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1036103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling