MEDICARE: MS. BRENDA KATHLEEN HUDSPETH LPC

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	101YP2500X	Professional Counselor	2017002250	MO

General Provider Information

NPI Number	:	1730614363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA KATHLEEN HUDSPETH LPC

Provider Business Mailing Address
First Line	:	1064 CALEB DR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2567
Country	:	US
Telephone Number	:	314-221-3287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1623 JEFFCO BLVD
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2737
Country	:	US
Telephone Number	:	314-221-3287
Fax Number	:

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

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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