| Doctor Name: | TANA HUDSON |
| NPI Number: | 1245500974 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW |
| License Number: | I-08462 |
| Business Practice Address: | 1202 Highway 60 Building D Socorro, NM - 878013914 |
| Business Phone Number: | 5758384690 |
| Business Fax Number: | 5758384689 |
| Mailing Address: | Po Box 26666, Phs Provider Enrollment ALBUQUERQUE |
| State: | NM |
| Postal Code: | 871256666 |
| Phone Number: | 5059236770 |
| Fax Number: | 5059235354 |
| NPI Enumeration Date: | 01/11/2012 |
| NPI Last Update Date: | 04/08/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-08462 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |