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General NPI Number Information
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NPI Number | 1801763669
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Entity Type | Individual
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Provider Name | JONATHAN TREVOR HUBBARD BCBA
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Gender | Male
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 3513 BRIARWOOD DR
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City | CATLETTSBURG
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State | KY
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Zip | 41129-9297
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Country | US
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Telephone | 304-972-7629
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Fax | 304-908-1083
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Provider Business Mailing Address
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Address Line | 3513 BRIARWOOD DR
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City | CATLETTSBURG
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State | KY
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Zip | 41129-9297
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Country | US
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Telephone | 304-972-7629
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Fax | 304-908-1083
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85084
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License Number State | WV
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