Healthcare Provider Details

I. General information

NPI: 1245929157
Provider Name (Legal Business Name): HODGES THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 MONROE PL
MONTCLAIR NJ
07042-4623
US

IV. Provider business mailing address

125 GLENRIDGE AVE # 374
MONTCLAIR NJ
07042-6800
US

V. Phone/Fax

Practice location:
  • Phone: 936-581-9289
  • Fax:
Mailing address:
  • Phone: 201-279-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AUSTIN HODGES
Title or Position: OWNER/COUNSELOR
Credential: LMHC
Phone: 936-581-9289