Provider Demographics
NPI:1235625500
Name:HUBBARD, TIMOTHY M (MS, MFT)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:M
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5359 FLOWING SPRING ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7676
Mailing Address - Country:US
Mailing Address - Phone:702-332-1251
Mailing Address - Fax:
Practice Address - Street 1:2501 N GREEN VALLEY PKWY STE 116118
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0273
Practice Address - Country:US
Practice Address - Phone:702-605-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist