Provider Demographics
NPI:1649597220
Name:HUDEFI MENTAL HEALTH SERVICES PLLC
Entity Type:Organization
Organization Name:HUDEFI MENTAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYZ
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUDEFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-353-0901
Mailing Address - Street 1:PO BOX 10674
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0674
Mailing Address - Country:US
Mailing Address - Phone:479-782-5500
Mailing Address - Fax:
Practice Address - Street 1:2010 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-782-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-22
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE47732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N608OtherBCBS
AR06070018900OtherQUALCHOICE
AR06070018900OtherQUALCHOICE
AR5N608OtherBCBS