Provider Demographics
NPI:1720193790
Name:SHUBS, CARL H (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:H
Last Name:SHUBS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S BEVERLY DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4303
Mailing Address - Country:US
Mailing Address - Phone:310-772-0520
Mailing Address - Fax:323-654-3032
Practice Address - Street 1:321 S BEVERLY DR
Practice Address - Street 2:SUITE L
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4303
Practice Address - Country:US
Practice Address - Phone:310-772-0520
Practice Address - Fax:323-654-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8912Medicare ID - Type Unspecified