Provider Demographics
NPI:1346457363
Name:RUBATT, MICHAEL D (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:RUBATT
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W COOLIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:IRONWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49938-1104
Mailing Address - Country:US
Mailing Address - Phone:906-932-1467
Mailing Address - Fax:906-229-6191
Practice Address - Street 1:103 WEST U.S. 2
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MI
Practice Address - Zip Code:49968
Practice Address - Country:US
Practice Address - Phone:906-229-6120
Practice Address - Fax:906-229-6191
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801087411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801087411OtherLIMITED LICENSED MSW