Healthcare Provider Details

I. General information

NPI: 1679768105
Provider Name (Legal Business Name): MICHELLE A HUBER B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17497 HIGHWAY 64 W
RANGELY CO
81648-2522
US

IV. Provider business mailing address

715 HORIZON DR STE 225
GRAND JUNCTION CO
81506-8743
US

V. Phone/Fax

Practice location:
  • Phone: 970-675-8411
  • Fax: 970-675-2508
Mailing address:
  • Phone: 970-675-8411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6797
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: