Provider Demographics
NPI:1326696618
Name:HUBBARD, ALTA LORRAINE (MSC, LAC)
Entity Type:Individual
Prefix:
First Name:ALTA
Middle Name:LORRAINE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:MSC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 N COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1649
Mailing Address - Country:US
Mailing Address - Phone:520-229-6220
Mailing Address - Fax:520-544-3033
Practice Address - Street 1:3131 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1649
Practice Address - Country:US
Practice Address - Phone:520-229-6220
Practice Address - Fax:520-544-3033
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17988101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health