Healthcare Provider Details

I. General information

NPI: 1437241023
Provider Name (Legal Business Name): EDWARD HUDSPETH R.PH., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2058 ROBISON RD
WATER VALLEY MS
38965-4056
US

IV. Provider business mailing address

2058 ROBISON RD
WATER VALLEY MS
38965-4056
US

V. Phone/Fax

Practice location:
  • Phone: 888-266-7044
  • Fax: 502-385-6539
Mailing address:
  • Phone: 888-266-7044
  • Fax: 502-385-6539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE07896
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD07685
License Number StateAR
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1108
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: