Provider Demographics
NPI:1730614363
Name:HUDSPETH, BRENDA KATHLEEN (LPC)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:KATHLEEN
Last Name:HUDSPETH
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 1:1064 CALEB DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2567
Mailing Address - Country:US
Mailing Address - Phone:314-221-3287
Mailing Address - Fax:
Practice Address - Street 1:1623 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2737
Practice Address - Country:US
Practice Address - Phone:314-221-3287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017002250101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional