Provider Demographics
NPI:1821219486
Name:HUDSON-LIBBY, MILLIE (MC LPC NCC)
Entity Type:Individual
Prefix:
First Name:MILLIE
Middle Name:
Last Name:HUDSON-LIBBY
Suffix:
Gender:F
Credentials:MC LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 N. 7TH STREET
Mailing Address - Street 2:C226
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2821
Mailing Address - Country:US
Mailing Address - Phone:602-279-5300
Mailing Address - Fax:602-266-1887
Practice Address - Street 1:5333 N. 7TH STREET
Practice Address - Street 2:C226
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2821
Practice Address - Country:US
Practice Address - Phone:602-279-5300
Practice Address - Fax:602-266-1887
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-1715101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ739401Medicaid