Healthcare Provider Details

I. General information

NPI: 1548742539
Provider Name (Legal Business Name): JETONA HUDSON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 RINGGOLD RD
SOMERSET KY
42503-3900
US

IV. Provider business mailing address

2865 CLAY HILL RD
SOMERSET KY
42501-6123
US

V. Phone/Fax

Practice location:
  • Phone: 606-451-1936
  • Fax:
Mailing address:
  • Phone: 606-382-9109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number301072
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: