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General NPI Number Information
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NPI Number | 1013441898
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Entity Type | Organization
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Legal Business Name | INSIGHTFULWAYS
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Dates
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Enumeration Date | 04/18/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 384 E OLIVE AVE STE 4
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City | TURLOCK
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State | CA
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Zip | 95380-4051
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Country | US
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Telephone | 209-675-0144
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Fax | 209-850-9411
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Provider Business Mailing Address
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Address Line | 384 E OLIVE AVE STE 4
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City | TURLOCK
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State | CA
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Zip | 95380-4051
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Country | US
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Telephone | 209-675-0144
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Fax | 209-850-9411
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Authorized Official
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Title or Position | CLINICIAN
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Name | DR. JONATHAN M HUDSON
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Credential | LCSW#74320
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Telephone | 209-675-0144
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LCSW#74320
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License Number State | CA
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