=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881417053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THERESE FREDDIE HUDLEY LPC ASSOICATE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2024
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1515 S CAPITAL OF TEXAS HWY STE 300
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78746-6544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-895-0098
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4900 W GATE BLVD APT 102
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78745-1428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 267-269-1875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 95862
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------