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NPI Code Detail

MEDICARE: MICHAEL ROSS HUDSON LCDC

MEDICARE: MICHAEL ROSS HUDSON LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor10478TX

General Provider Information

NPI Number : 1508101015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ROSS HUDSON LCDC
Provider Business Mailing Address
First Line : 7510 FM 1765 BLDG 1
Second Line :
City : TEXAS CITY
State : TX
Zip : 77591-3672
Country : US
Telephone Number : 409-944-4399
Fax Number :
Provider Business Practice Location Address
First Line : 7510 FM 1765 BLDG 1
Second Line :
City : TEXAS CITY
State : TX
Zip : 77591-3672
Country : US
Telephone Number : 409-944-4399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/10/2012
Last Update Date : 12/10/2012

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