MEDICARE: NANCY HUDGINS MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	01230	MN

General Provider Information

NPI Number	:	1457781114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY HUDGINS MA, LPC

Provider Business Mailing Address
First Line	:	1821 UNIVERSITY AVE W
Second Line	:	SUITE N-180
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-2801
Country	:	US
Telephone Number	:	651-348-8073
Fax Number	:	651-348-8968

Provider Business Practice Location Address
First Line	:	1437 MARSHALL AVE
Second Line	:	SUITE 106
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-6350
Country	:	US
Telephone Number	:	612-600-3827
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2013
Last Update Date	:	12/01/2013

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