Provider Demographics
NPI:1629176425
Name:DUBIE, GEORGE (LP)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:DUBIE
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11208 HIGHWAY 71 NE
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-9311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:513 5TH ST SW
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3216
Practice Address - Country:US
Practice Address - Phone:320-214-9692
Practice Address - Fax:320-214-9924
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1435103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122231OtherBHP/UCARE
MN05Q38DUOtherBCBS
MN62-54678OtherUBH/MEDICA
MN35581OtherHEALTHPARTNERS