Provider Demographics
NPI:1790274132
Name:HUDSON, AUSTIN ERIC
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:ERIC
Last Name:HUDSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 S LAMAR BLVD STE 12
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-4789
Mailing Address - Country:US
Mailing Address - Phone:512-851-0950
Mailing Address - Fax:
Practice Address - Street 1:2525 S LAMAR BLVD STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-4789
Practice Address - Country:US
Practice Address - Phone:512-851-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-01
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85947101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional