Healthcare Provider Details

I. General information

NPI: 1679994545
Provider Name (Legal Business Name): TERESA BUBNIS LLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2013
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRESTIGE PL
MIAMISBURG OH
45342-3794
US

IV. Provider business mailing address

1 PRESTIGE PL
MIAMISBURG OH
45342-3794
US

V. Phone/Fax

Practice location:
  • Phone: 708-530-0625
  • Fax:
Mailing address:
  • Phone: 708-530-0625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401009261
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE1901170
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: