Provider Demographics
NPI:1164986261
Name:HUBERT, KATHERINE (RBT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:HUBERT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:SHEPHERD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:249 W CORAL DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1790
Mailing Address - Country:US
Mailing Address - Phone:541-314-3187
Mailing Address - Fax:
Practice Address - Street 1:304 INVERNESS WAY S STE 125
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5820
Practice Address - Country:US
Practice Address - Phone:303-759-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-18-59702106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician