Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003187345 |
---|---|
Provider Name | Mr. Preston John Hudson |
First Address | Durant, OK 74701-2128 |
Second Address | Durant, OK 74701-2128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2012 |
Last Update Date | 18/01/2012 |