Provider Demographics
NPI:1104903236
Name:HUDLET, KIMBERLY LYNN (LCPC)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNN
Last Name:HUDLET
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 N CLOVERDALE RD STE 214
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1068
Mailing Address - Country:US
Mailing Address - Phone:000-000-0000
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:4700 N CLOVERDALE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-1081
Practice Address - Country:US
Practice Address - Phone:208-376-4819
Practice Address - Fax:866-305-0713
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1063004101YA0400X
IDLCPC 2838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)