1881133007 NPI number — MRS. REBECCA LYNN HUDOCK M.A, LPC

Table of content: MRS. REBECCA LYNN HUDOCK M.A, LPC (NPI 1881133007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881133007 NPI number — MRS. REBECCA LYNN HUDOCK M.A, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUDOCK
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GILLEN
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881133007
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 A. MORGANTOWN ST.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-880-4009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8320 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRWIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15642-2719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-863-7223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/21/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PC009405 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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