MEDICARE: DIANA S HUBBERTS LCPC, MS

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	180.006755	IL

General Provider Information

NPI Number	:	1881854446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA S HUBBERTS LCPC, MS

Provider Business Mailing Address
First Line	:	1815 E LILAC TER
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3528
Country	:	US
Telephone Number	:	847-818-8629
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 E LILAC TER
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-3528
Country	:	US
Telephone Number	:	847-818-8629
Fax Number	:

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

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	07/14/2008

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