Provider Demographics
NPI:1508956947
Name:HUBBARD, GARY LEE (MS, LCPC, LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:LEE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:MS, LCPC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5182 CROFTON DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5424
Mailing Address - Country:US
Mailing Address - Phone:815-877-2882
Mailing Address - Fax:815-877-8912
Practice Address - Street 1:5182 CROFTON DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5424
Practice Address - Country:US
Practice Address - Phone:815-877-2882
Practice Address - Fax:815-877-8912
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3294-125101YP2500X
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0010122558OtherBCBS PROVIDER #
IL025896000-19412277OtherMAGELLAN PROVIDER #
CA359327OtherMANAGED HEALTH NETWORK PI