MEDICARE: MARALEE HUBBLE MA, LMFT, LCPC

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	2918	ID
2	106H00000X	Marriage & Family Therapist	3016	ID
3	101YM0800X	Mental Health Counselor	LCPC2918	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10140940	OTHER	ID	REGENCE BLUE SHIELD OF ID
2	Q4228	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1942345558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARALEE HUBBLE MA, LMFT, LCPC

Provider Business Mailing Address
First Line	:	1740 N MILWAUKEE ST STE B
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-7107
Country	:	US
Telephone Number	:	208-350-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1740 N MILWAUKEE ST STE B
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-7107
Country	:	US
Telephone Number	:	208-577-8565
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	01/30/2019

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