Provider Demographics
NPI:1366672602
Name:HUBBELL, ANDREA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:MATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LP
Mailing Address - Street 1:1000 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840
Mailing Address - Country:US
Mailing Address - Phone:419-434-5875
Mailing Address - Fax:
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-3653
Practice Address - Country:US
Practice Address - Phone:419-434-5785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9460101Y00000X
OH7323103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470376606-31Medicaid