Provider Demographics
NPI:1760753909
Name:JODY L. HUGHES LLC
Entity Type:Organization
Organization Name:JODY L. HUGHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:LILLICH
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:574-855-7730
Mailing Address - Street 1:202 S. MICHIGAN ST
Mailing Address - Street 2:SUITE 875
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2021
Mailing Address - Country:US
Mailing Address - Phone:574-855-7730
Mailing Address - Fax:574-988-0167
Practice Address - Street 1:202 S. MICHIGAN ST
Practice Address - Street 2:SUITE 875
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2021
Practice Address - Country:US
Practice Address - Phone:574-855-7730
Practice Address - Fax:574-988-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005886A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11490425OtherCAQH
1225283039OtherINDIVIDUAL NPI. FOR JODY HUGHES.