Healthcare Provider Details

I. General information

NPI: 1568080042
Provider Name (Legal Business Name): CYD DAVIS-HUBLER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 07/10/2020
Certification Date: 07/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 INDIAN SCHOOL RD NE STE 200F
ALBUQUERQUE NM
87112-2884
US

IV. Provider business mailing address

4211 LOUISIANA BLVD NE APT 1121
ALBUQUERQUE NM
87109-1842
US

V. Phone/Fax

Practice location:
  • Phone: 505-308-2028
  • Fax:
Mailing address:
  • Phone: 317-989-4579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA DAVIS-HUBLER
Title or Position: COUNSELOR
Credential: LPCC
Phone: 317-989-4579