Provider Demographics
NPI:1639382930
Name:JUBERG, ARIEL N (MA, PSYD, LLC)
Entity Type:Individual
Prefix:DR
First Name:ARIEL
Middle Name:N
Last Name:JUBERG
Suffix:
Gender:F
Credentials:MA, PSYD, LLC
Other - Prefix:
Other - First Name:ARIEL
Other - Middle Name:N
Other - Last Name:OLEARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1870 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5650
Mailing Address - Country:US
Mailing Address - Phone:616-956-1122
Mailing Address - Fax:616-956-8033
Practice Address - Street 1:1870 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5650
Practice Address - Country:US
Practice Address - Phone:616-956-1122
Practice Address - Fax:616-956-8033
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.004092101YP2500X
MI6301014716103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional