Provider Demographics
NPI:1407500242
Name:HUBBARD, KATRINA (LPC-US)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPC-US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 N MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-6447
Mailing Address - Country:US
Mailing Address - Phone:918-949-4212
Mailing Address - Fax:918-949-2499
Practice Address - Street 1:3606 N MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74106-6447
Practice Address - Country:US
Practice Address - Phone:918-949-4212
Practice Address - Fax:918-949-2499
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health