Provider Demographics
NPI:1538377973
Name:KRISTEN A. HUDACEK, PSY.D., PLC
Entity type:Organization
Organization Name:KRISTEN A. HUDACEK, PSY.D., PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:HUDACEK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:813-610-6007
Mailing Address - Street 1:5701 MARINER ST
Mailing Address - Street 2:#402
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3442
Mailing Address - Country:US
Mailing Address - Phone:813-610-6007
Mailing Address - Fax:
Practice Address - Street 1:8019 N HIMES AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2712
Practice Address - Country:US
Practice Address - Phone:813-610-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7334251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health