Provider Demographics
NPI:1568853802
Name:HODGSON, JASON TYLER (PCCI)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TYLER
Last Name:HODGSON
Suffix:
Gender:M
Credentials:PCCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 OREGON ST STE 216
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1757
Mailing Address - Country:US
Mailing Address - Phone:530-206-5560
Mailing Address - Fax:
Practice Address - Street 1:1650 OREGON ST STE 216
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1757
Practice Address - Country:US
Practice Address - Phone:530-206-5560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional