Healthcare Provider Details

I. General information

NPI: 1023870425
Provider Name (Legal Business Name): HOPE ELISE HUDSON M.S., LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 01/30/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 S MUSTANG RD STE B
YUKON OK
73099-7314
US

IV. Provider business mailing address

3832 NW 64TH ST
OKLAHOMA CITY OK
73116-1916
US

V. Phone/Fax

Practice location:
  • Phone: 405-254-7746
  • Fax:
Mailing address:
  • Phone: 405-808-0645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCCANDIDATE11992
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: