Provider Demographics
NPI:1720840069
Name:HUDSON, LAUREN LEIGH
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEIGH
Last Name:HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LEIGH
Other - Last Name:BALAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3041
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654-3077
Mailing Address - Country:US
Mailing Address - Phone:512-710-0551
Mailing Address - Fax:512-717-6337
Practice Address - Street 1:5524 BEE CAVES RD STE H2
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5246
Practice Address - Country:US
Practice Address - Phone:512-710-0551
Practice Address - Fax:512-717-6337
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81578101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX476670101Medicaid