MEDICARE: MS. TAMALA S. HUBBARD L.P.C.

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	101YP2500X	Professional Counselor	7395235-6004	UT

General Provider Information

NPI Number	:	1275697740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMALA S. HUBBARD L.P.C.

Provider Business Mailing Address
First Line	:	3070 RASMUSSEN RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5486
Country	:	US
Telephone Number	:	435-640-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	3070 RASMUSSEN RD
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-5486
Country	:	US
Telephone Number	:	435-640-4565
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	04/02/2014

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