Provider Demographics
NPI:1578274155
Name:JLG HUDAK LLC
Entity type:Organization
Organization Name:JLG HUDAK LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:N
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-568-3801
Mailing Address - Street 1:1150 FIRST AVE STE 511
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:BRADFORDWOODS
Practice Address - State:PA
Practice Address - Zip Code:15015-1328
Practice Address - Country:US
Practice Address - Phone:412-568-3801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC013866OtherCOMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU
DCPRC200001358OtherTHE GOVERNMENT OF THE DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH BOARD OF PROFESS