MEDICARE: ALTA LORRAINE HUBBARD MSC, LAC

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	17988	AZ

General Provider Information

NPI Number	:	1326696618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALTA LORRAINE HUBBARD MSC, LAC

Provider Business Mailing Address
First Line	:	3131 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1649
Country	:	US
Telephone Number	:	520-229-6220
Fax Number	:	520-544-3033

Provider Business Practice Location Address
First Line	:	3131 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-1649
Country	:	US
Telephone Number	:	520-229-6220
Fax Number	:	520-544-3033

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	08/29/2019

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