Provider Demographics
NPI:1598485211
Name:HUBERT, MRYIA KELLEY (MGC, CGC)
Entity Type:Individual
Prefix:
First Name:MRYIA
Middle Name:KELLEY
Last Name:HUBERT
Suffix:
Gender:F
Credentials:MGC, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 DIVISION ST APT 436
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4437
Mailing Address - Country:US
Mailing Address - Phone:262-355-5975
Mailing Address - Fax:
Practice Address - Street 1:1500 21ST AVE S STE 2500
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-3157
Practice Address - Country:US
Practice Address - Phone:615-343-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS