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General NPI Number Information
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NPI Number | 1649955063
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Entity Type | Individual
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Provider Name | NICHOLAS BRIAN HUBLER CADC-R/QMHA-I
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Gender | Male
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1438 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97202-1140
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Country | US
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Telephone | 503-548-0346
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Fax | 503-232-5959
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Provider Business Mailing Address
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Address Line | 211 SE CARUTHERS ST
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City | PORTLAND
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State | OR
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Zip | 97214-4502
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Country | US
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Telephone | 503-224-1044
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Fax | 971-260-0355
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | T-25-5495
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 25-QMHA-I-005045
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License Number State | OR
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