Provider Demographics
NPI:1821384744
Name:HUDSON, DONALD R (QBA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:HUDSON
Suffix:
Gender:M
Credentials:QBA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1350 E FLAMINGO RD
Mailing Address - Street 2:BOX 577
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5263
Mailing Address - Country:US
Mailing Address - Phone:702-202-2902
Mailing Address - Fax:702-202-6551
Practice Address - Street 1:3430 E FLAMINGO RD
Practice Address - Street 2:STE 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5003
Practice Address - Country:US
Practice Address - Phone:702-202-2902
Practice Address - Fax:702-202-6551
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005055395Medicaid