Healthcare Provider Details

I. General information

NPI: 1760215826
Provider Name (Legal Business Name): CARLA J. HUBBARD ED.S., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6291 CAMBRIDGE WAY STE 200
PLAINFIELD IN
46168-7944
US

IV. Provider business mailing address

6291 CAMBRIDGE WAY STE 200
PLAINFIELD IN
46168-7944
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-8436
  • Fax: 317-718-8438
Mailing address:
  • Phone: 317-718-8436
  • Fax: 317-718-8438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39005086A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: