Provider Demographics
NPI:1265766547
Name:ELLIOTT-HUDSON, KATHRYN (MED ,LISAC, NCGC-II)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:ELLIOTT-HUDSON
Suffix:
Gender:F
Credentials:MED ,LISAC, NCGC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 E SHEA BLVD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6423
Mailing Address - Country:US
Mailing Address - Phone:480-991-9818
Mailing Address - Fax:
Practice Address - Street 1:7219 E SHEA BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6423
Practice Address - Country:US
Practice Address - Phone:480-991-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10665101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)