Provider Demographics
NPI:1659667830
Name:HUBBARD, KIMALA J
Entity Type:Individual
Prefix:
First Name:KIMALA
Middle Name:J
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 OAK GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3730
Mailing Address - Country:US
Mailing Address - Phone:405-408-7029
Mailing Address - Fax:
Practice Address - Street 1:7401 NE 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73141-1420
Practice Address - Country:US
Practice Address - Phone:405-408-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11194OtherOKLAHOMA DEPARTMENT OF MENTAL HEALTH