Provider Demographics
NPI:1073852166
Name:RUDASILL, ANNA LEAH (LPC)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:LEAH
Last Name:RUDASILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-0416
Mailing Address - Country:US
Mailing Address - Phone:254-778-4673
Mailing Address - Fax:254-526-4853
Practice Address - Street 1:1805 FLORENCE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-8523
Practice Address - Country:US
Practice Address - Phone:254-526-4673
Practice Address - Fax:254-526-4853
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional