Provider Demographics
NPI:1942358171
Name:HUDSON, PAUL EDWARD (LPC, LISAC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWARD
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LPC, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 E SAN TAN DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-3611
Mailing Address - Country:US
Mailing Address - Phone:480-635-9586
Mailing Address - Fax:480-812-9669
Practice Address - Street 1:2716 N DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1806
Practice Address - Country:US
Practice Address - Phone:480-635-9586
Practice Address - Fax:480-812-9669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11611101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health