Provider Demographics
NPI:1053472621
Name:KUBE, DONALD A (LMFT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:A
Last Name:KUBE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 CLIFFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-8393
Mailing Address - Country:US
Mailing Address - Phone:608-769-3560
Mailing Address - Fax:
Practice Address - Street 1:571 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-785-7000
Practice Address - Fax:608-785-7477
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI309 - 124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39765300Medicaid
MN13G86KUOtherBCBS-MN
WI39765300Medicaid