Provider Demographics
NPI:1467646901
Name:SHUBIN, CHAD (MFT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:SHUBIN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 E 300 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3539
Mailing Address - Country:US
Mailing Address - Phone:801-377-1213
Mailing Address - Fax:
Practice Address - Street 1:55 S 500 E
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1918
Practice Address - Country:US
Practice Address - Phone:435-654-3003
Practice Address - Fax:435-654-0309
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6742410-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist