Healthcare Provider Details

I. General information

NPI: 1023867116
Provider Name (Legal Business Name): THERESE HUDGINS OGLE LPA, LSSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THERESE LYNN HUDGINS

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FARINGDON DR
PLANO TX
75075-2746
US

IV. Provider business mailing address

1541 FARINGDON DR
PLANO TX
75075-2746
US

V. Phone/Fax

Practice location:
  • Phone: 214-808-3150
  • Fax:
Mailing address:
  • Phone: 214-808-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number15134
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number6345
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number15134
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: