MEDICARE: CORY JUBITZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194531848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY JUBITZ

Provider Business Mailing Address
First Line	:	PO BOX 933
Second Line	:
City	:	BINGEN
State	:	WA
Zip	:	98605-1633
Country	:	US
Telephone Number	:	541-788-7305
Fax Number	:

Provider Business Practice Location Address
First Line	:	207 E FRANKLIN ST
Second Line	:
City	:	BINGEN
State	:	WA
Zip	:	98605-9131
Country	:	US
Telephone Number	:	541-788-7305
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2024
Last Update Date	:	12/07/2024

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Directions to “ CORY JUBITZ ” Practice Location

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