Provider Demographics
NPI:1073377271
Name:HUBBARD, SHANTI GINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANTI
Middle Name:GINA
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4728 CLOVER ST APT B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-4042
Mailing Address - Country:US
Mailing Address - Phone:310-704-4437
Mailing Address - Fax:
Practice Address - Street 1:4728 CLOVER ST APT B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-4042
Practice Address - Country:US
Practice Address - Phone:310-704-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX90971101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health