Provider Demographics
NPI:1326257817
Name:HUBBARD, CARLA (LICENSED THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LICENSED THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 MURRELL ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:LA
Mailing Address - Zip Code:71055-3423
Mailing Address - Country:US
Mailing Address - Phone:318-773-0017
Mailing Address - Fax:
Practice Address - Street 1:206 MURRELL ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:LA
Practice Address - Zip Code:71055-3423
Practice Address - Country:US
Practice Address - Phone:318-773-0017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA2739-02172M00000X
LA99240009175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered172M00000XOther Service ProvidersMechanotherapist
Not Answered175L00000XOther Service ProvidersHomeopath