Provider Demographics
NPI:1912081761
Name:HUDSON, GORDON WILLIS III (MSW, LPC)
Entity Type:Individual
Prefix:MR
First Name:GORDON
Middle Name:WILLIS
Last Name:HUDSON
Suffix:III
Gender:M
Credentials:MSW, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E SONTERRA BLVD
Mailing Address - Street 2:STE. #230
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4054
Mailing Address - Country:US
Mailing Address - Phone:210-545-6860
Mailing Address - Fax:210-545-6869
Practice Address - Street 1:325 E SONTERRA BLVD
Practice Address - Street 2:STE. #230
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4054
Practice Address - Country:US
Practice Address - Phone:210-545-6860
Practice Address - Fax:210-545-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8296101Y00000X
TX001236-042307106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84464LOtherBLUE CROSS/BLUE SHIELD