Provider Demographics
NPI:1437583838
Name:JOUBERT, HOLLY JINDRICK (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:JINDRICK
Last Name:JOUBERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HOUGHTON RD
Mailing Address - Street 2:#138-200
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-6731
Mailing Address - Country:US
Mailing Address - Phone:520-344-0056
Mailing Address - Fax:
Practice Address - Street 1:5210 E PIMA ST
Practice Address - Street 2:#105
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3664
Practice Address - Country:US
Practice Address - Phone:520-344-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3963103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ12560713OtherCAQH