Provider Demographics
NPI:1073699740
Name:STUBE, DAVID BENNETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENNETT
Last Name:STUBE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 STEPHENS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3813
Mailing Address - Country:US
Mailing Address - Phone:406-542-8222
Mailing Address - Fax:406-542-1590
Practice Address - Street 1:537 STEPHENS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3813
Practice Address - Country:US
Practice Address - Phone:406-542-8222
Practice Address - Fax:406-542-1590
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT364101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional