MEDICARE: STACI HUBBARD LPCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	175343	KY

General Provider Information

NPI Number	:	1124525688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI HUBBARD LPCA

Provider Business Mailing Address
First Line	:	3540 S HIGHWAY 27 STE 4
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3124
Country	:	US
Telephone Number	:	606-679-1815
Fax Number	:	606-451-1631

Provider Business Practice Location Address
First Line	:	3540 S HIGHWAY 27 STE 4
Second Line	:
City	:	SOMERSET
State	:	KY
Zip	:	42501-3124
Country	:	US
Telephone Number	:	606-679-1815
Fax Number	:	606-451-1631

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	04/11/2018

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Directions to “ STACI HUBBARD LPCA” Practice Location

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