Provider Demographics
NPI:1275697740
Name:HUBBARD, TAMALA S (LPC)
Entity Type:Individual
Prefix:MS
First Name:TAMALA
Middle Name:S
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:HUBBARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3070 RASMUSSEN RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5486
Mailing Address - Country:US
Mailing Address - Phone:435-640-4565
Mailing Address - Fax:
Practice Address - Street 1:3070 RASMUSSEN RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84098-5486
Practice Address - Country:US
Practice Address - Phone:435-640-4565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7395235-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional