Provider Demographics
NPI:1841416260
Name:HUDSON, BRADY LEE JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:LEE
Last Name:HUDSON
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 HEATHERBROOOK DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312
Mailing Address - Country:US
Mailing Address - Phone:850-892-1263
Mailing Address - Fax:
Practice Address - Street 1:400 S PINETREE BLVD
Practice Address - Street 2:BLDG 414-A - FORENSIC SERVICES
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7128
Practice Address - Country:US
Practice Address - Phone:229-227-2930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7427103TC0700X, 103TF0200X, 103TH0100X, 103TH0004X
GAPSY003115103TC0700X, 103TF0200X, 103TH0004X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth