Provider Demographics
NPI:1174692172
Name:HUDAK, ANDREW JAMES III (LCPC)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:HUDAK
Suffix:III
Gender:M
Credentials:LCPC
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:HUDAK
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:PO BOX 1763
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-1763
Mailing Address - Country:US
Mailing Address - Phone:406-862-1112
Mailing Address - Fax:406-862-1112
Practice Address - Street 1:309 WISCONSIN AVE
Practice Address - Street 2:ATTN:ANDY
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2319
Practice Address - Country:US
Practice Address - Phone:406-862-1112
Practice Address - Fax:406-862-1112
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT47 LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health