MEDICARE: KAROL LYNN CHUBB

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	106H00000X	Marriage & Family Therapist	4101007413	MI

General Provider Information

NPI Number	:	1528710076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAROL LYNN CHUBB

Provider Business Mailing Address
First Line	:	1048 DUQUESA DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9392
Country	:	US
Telephone Number	:	810-986-1780
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 DUQUESA DR
Second Line	:
City	:	LAKE ISABELLA
State	:	MI
Zip	:	48893-9392
Country	:	US
Telephone Number	:	810-986-1780
Fax Number	:

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

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	09/24/2024

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