Healthcare Provider Details

I. General information

NPI: 1922126549
Provider Name (Legal Business Name): CAROL LYNN HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17328 DESTINY LOOP
PRINCETON MO
64673-9822
US

IV. Provider business mailing address

17328 DESTINY LOOP
PRINCETON MO
64673-9822
US

V. Phone/Fax

Practice location:
  • Phone: 660-952-0182
  • Fax:
Mailing address:
  • Phone: 660-952-0182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: