Healthcare Provider Details

I. General information

NPI: 1861210965
Provider Name (Legal Business Name): BARBARA HUBBARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S CENTRAL AVE STE 101D
MEDFORD OR
97501-7808
US

IV. Provider business mailing address

724 S CENTRAL AVE STE 101D
MEDFORD OR
97501-7808
US

V. Phone/Fax

Practice location:
  • Phone: 541-249-7724
  • Fax:
Mailing address:
  • Phone: 541-249-7724
  • Fax: 541-325-4055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: