MEDICARE: ERIC RUDD LPCC

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	294457	KY

General Provider Information

NPI Number	:	1558183319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC RUDD LPCC

Provider Business Mailing Address
First Line	:	4010 DUPONT CIR STE B173
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 MAPLE ST STE 2
Second Line	:
City	:	MURRAY
State	:	KY
Zip	:	42071-2540
Country	:	US
Telephone Number	:	502-339-4201
Fax Number	:

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

Provider Enumeration Date	:	10/31/2024
Last Update Date	:	10/31/2024

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Directions to “ ERIC RUDD LPCC” Practice Location

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