Provider Demographics
NPI:1942442645
Name:HUDSON, SHIRLEY ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:ANN
Last Name:HUDSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 N MERIDIAN ST
Mailing Address - Street 2:SUITE 176
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4436
Mailing Address - Country:US
Mailing Address - Phone:317-226-2825
Mailing Address - Fax:317-226-3725
Practice Address - Street 1:3401 N MERIDIAN ST
Practice Address - Street 2:SUITE 176
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4436
Practice Address - Country:US
Practice Address - Phone:317-226-2825
Practice Address - Fax:317-226-3725
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN904578101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN904578OtherCOUNSELOR-PROFESSIONAL
IN904578OtherCOUNSELOR SCHOOL