Provider Demographics
NPI:1073154936
Name:RUBBERT, MICHELLE (LMHCA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RUBBERT
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BOLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 LAKERIDGE WAY SW STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-6081
Mailing Address - Country:US
Mailing Address - Phone:360-995-8775
Mailing Address - Fax:
Practice Address - Street 1:921 LAKERIDGE WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-6081
Practice Address - Country:US
Practice Address - Phone:360-995-8775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-02
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health