Provider Demographics
NPI:1376878835
Name:HUBBARD, ELIZABETH ANN (CRC, PLPC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:CRC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 EXECUTIVE PARKWAY DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6323
Mailing Address - Country:US
Mailing Address - Phone:314-852-3941
Mailing Address - Fax:314-434-2331
Practice Address - Street 1:1023 EXECUTIVE PARKWAY DR
Practice Address - Street 2:SUITE 8
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6323
Practice Address - Country:US
Practice Address - Phone:314-852-3941
Practice Address - Fax:314-434-2331
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007020132101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health