Provider Demographics
NPI:1881417053
Name:HUDLEY, THERESE FREDDIE (LPC ASSOICATE)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:FREDDIE
Last Name:HUDLEY
Suffix:
Gender:F
Credentials:LPC ASSOICATE
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:HUDGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4900 W GATE BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1428
Mailing Address - Country:US
Mailing Address - Phone:267-269-1875
Mailing Address - Fax:
Practice Address - Street 1:1515 S CAPITAL OF TEXAS HWY STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-6544
Practice Address - Country:US
Practice Address - Phone:832-895-0098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX95862101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health