Provider Demographics
NPI:1568954188
Name:HUBCHIK, JORDAN (LPC, LCAT, ATR-BC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HUBCHIK
Suffix:
Gender:F
Credentials:LPC, LCAT, ATR-BC
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5305 RIVER RD N STE B
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-5324
Mailing Address - Country:US
Mailing Address - Phone:503-713-5674
Mailing Address - Fax:503-713-5675
Practice Address - Street 1:5305 RIVER RD N STE B
Practice Address - Street 2:
Practice Address - City:KEIZER
Practice Address - State:OR
Practice Address - Zip Code:97303-5324
Practice Address - Country:US
Practice Address - Phone:503-713-5674
Practice Address - Fax:503-713-5675
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR5405101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR5405OtherLPC INTERN REGISTRATION