Provider Demographics
NPI:1588616007
Name:DUBIN, JOHN W (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:W
Last Name:DUBIN
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4954 STATE HIGHWAY KK
Mailing Address - Street 2:
Mailing Address - City:FRIEDHEIM
Mailing Address - State:MO
Mailing Address - Zip Code:63747-7423
Mailing Address - Country:US
Mailing Address - Phone:573-788-2238
Mailing Address - Fax:
Practice Address - Street 1:619 N BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4313
Practice Address - Country:US
Practice Address - Phone:573-334-3486
Practice Address - Fax:573-334-3524
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003011048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
658396OtherHELATHLINK PPO/FREEDOM
188428OtherBC/BS
5633815OtherFIRST HEALTH NETWORK