Healthcare Provider Details

I. General information

NPI: 1023594769
Provider Name (Legal Business Name): ABRAHAM HUDSON ACMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 W CENTER ST
OREM UT
84057-5201
US

IV. Provider business mailing address

853 W CENTER ST
OREM UT
84057-5201
US

V. Phone/Fax

Practice location:
  • Phone: 801-358-4463
  • Fax:
Mailing address:
  • Phone: 801-358-4463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8055847-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: