Healthcare Provider Details

I. General information

NPI: 1003223777
Provider Name (Legal Business Name): JOVITA HUBBARD MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 115TH ST
CHICAGO IL
60628-5015
US

IV. Provider business mailing address

903 W. 60TH PLACE
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 773-291-2500
  • Fax:
Mailing address:
  • Phone: 219-613-6128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010979
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: