Healthcare Provider Details

I. General information

NPI: 1851620165
Provider Name (Legal Business Name): ANDREW WILLIAM HUBER MA, NCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N 67TH AVE
PHOENIX AZ
85033-4517
US

IV. Provider business mailing address

2527 W BISBEE WAY
ANTHEM AZ
85086-2389
US

V. Phone/Fax

Practice location:
  • Phone: 623-691-4085
  • Fax:
Mailing address:
  • Phone: 623-551-2626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: