Provider Demographics
NPI:1487805404
Name:HUDSON, SHANE D (LMLP)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:D
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-8537
Mailing Address - Country:US
Mailing Address - Phone:785-825-6224
Mailing Address - Fax:785-825-7595
Practice Address - Street 1:617 E ELM ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-8537
Practice Address - Country:US
Practice Address - Phone:785-825-6224
Practice Address - Fax:785-825-7595
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1267103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist