MEDICARE: KOREN RENEE HUDSON 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	LPC-17621	AZ

General Provider Information

NPI Number	:	1952958928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOREN RENEE HUDSON LPC

Provider Business Mailing Address
First Line	:	5320 E SHEA BLVD STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-4793
Country	:	US
Telephone Number	:	602-652-0163
Fax Number	:

Provider Business Practice Location Address
First Line	:	5230 E SHEA BLVD STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85254-5751
Country	:	US
Telephone Number	:	602-652-0163
Fax Number	:

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

Provider Enumeration Date	:	08/23/2019
Last Update Date	:	08/24/2020

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