MEDICARE: JENNIFER DEBORA HUDSON MA, LMHC, CMHS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LH60172378	WA

General Provider Information

NPI Number	:	1003007691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DEBORA HUDSON MA, LMHC, CMHS

Provider Business Mailing Address
First Line	:	1906 82ND AVE NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258-6472
Country	:	US
Telephone Number	:	425-210-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 82ND AVE NE
Second Line	:
City	:	LAKE STEVENS
State	:	WA
Zip	:	98258
Country	:	US
Telephone Number	:	425-397-6284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	10/25/2013

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