Jacob Charles Hudanick, LPC-T

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

04885-T Issued in KS

Practice address

555 N Woodlawn St
Wichita, KS 67208-3646

Phone

(636) 248-5979

NPI assigned

Nov 4, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2024

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Health America of South Central Kansas, Inc.

  • Community/Behavioral Health Agency
  • Wichita, KS
  • NPI 1689710568

  KS

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1184447641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3324 E SUNFLOWER DR",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670378688",
            "telephone_number": "636-248-5979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N WOODLAWN ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672083646",
            "telephone_number": "636-248-5979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDANICK",
        "first_name": "JACOB",
        "middle_name": "CHARLES",
        "credential": "LPC-T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "KS",
            "license": "04885-T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zachary Caleb Huber, RN
• Travis D Hubin, DO
• Marilyn Joyce Huck, M.S. CCC-SLP
• Robyn Huckaby, ARNP
• Alicia A. Huckstadt, PHD, ARNP, FNP
• Hudson Holdings, Inc
• Hudson Holdings, Inc
• Jennifer Hudson, LAT, ATC
• Joshua Hudson, MD
• Marquee Hudson

• All providers in Wichita, KS
• Professional Counselor in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.