Provider Demographics
NPI:1063922920
Name:HUDSON, BRADLEY ROBERT (LMFT)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:HUDSON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W LAKEWAY RD STE 902
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6345
Mailing Address - Country:US
Mailing Address - Phone:307-209-4649
Mailing Address - Fax:307-381-0493
Practice Address - Street 1:201 W LAKEWAY RD STE 902
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6345
Practice Address - Country:US
Practice Address - Phone:307-209-4649
Practice Address - Fax:307-381-0493
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-05
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT-234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
922436337OtherEINS