MEDICARE: MR. GORDON HUDSON MSW LPC PHD

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	106H00000X	Marriage & Family Therapist	001236-042307	TX
2	101Y00000X	Counselor	8296	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	84464L	OTHER	TX	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1912081761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GORDON HUDSON MSW LPC PHD

Provider Business Mailing Address
First Line	:	325 E SONTERRA BLVD
Second Line	:	STE. #230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4054
Country	:	US
Telephone Number	:	210-545-6860
Fax Number	:	210-545-6869

Provider Business Practice Location Address
First Line	:	325 E SONTERRA BLVD
Second Line	:	STE. #230
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4054
Country	:	US
Telephone Number	:	210-545-6860
Fax Number	:	210-545-6869

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	04/08/2025

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