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NPI Code Detail

MEDICARE: CLETIS HUBBARD

MEDICARE: CLETIS HUBBARD
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1871097634
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLETIS HUBBARD
Provider Business Mailing Address
First Line : 55 BEATTIE PL STE 810
Second Line :
City : GREENVILLE
State : SC
Zip : 29601-2191
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6733 CAMP BOWIE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76116-7112
Country : US
Telephone Number : 817-386-9180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2018
Last Update Date : 03/19/2018

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Directions to “ CLETIS HUBBARD ” Practice Location

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