Provider Demographics
NPI:1437801271
Name:HUBER, MARY KAY (BS, CADC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:HUBER
Suffix:
Gender:F
Credentials:BS, CADC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:LULAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:731 SABRINA DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:EAST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61611-3582
Mailing Address - Country:US
Mailing Address - Phone:309-699-9700
Mailing Address - Fax:309-699-2937
Practice Address - Street 1:731 SABRINA DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-3581
Practice Address - Country:US
Practice Address - Phone:309-699-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34591101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)