Healthcare Provider Details

I. General information

NPI: 1679683700
Provider Name (Legal Business Name): JASON MATTHEW CUBBIN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 2ND AVE
KOTZEBUE AK
99752-0256
US

IV. Provider business mailing address

PO BOX 256
KOTZEBUE AK
99752-0256
US

V. Phone/Fax

Practice location:
  • Phone: 907-442-7640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009141
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: