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General NPI Number Information
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NPI Number | 1003007691
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Entity Type | Individual
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Provider Name | JENNIFER DEBORA HUDSON MA, LMHC, CMHS
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Gender | Female
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Dates
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Enumeration Date | 08/07/2007
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Last Update Date | 10/25/2013
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Provider Practice Location Address
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Address Line | 1906 82ND AVE NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258
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Country | US
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Telephone | 425-397-6284
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Fax |
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Provider Business Mailing Address
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Address Line | 1906 82ND AVE NE
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City | LAKE STEVENS
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State | WA
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Zip | 98258-6472
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Country | US
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Telephone | 425-210-3328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH60172378
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License Number State | WA
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