Provider Demographics
NPI:1750654976
Name:HUEBLPSYCH, PC
Entity Type:Organization
Organization Name:HUEBLPSYCH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUEBL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:970-223-2256
Mailing Address - Street 1:300 BOARDWALK DR
Mailing Address - Street 2:5-A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3070
Mailing Address - Country:US
Mailing Address - Phone:970-223-2256
Mailing Address - Fax:970-223-2324
Practice Address - Street 1:300 BOARDWALK DR
Practice Address - Street 2:5-A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3070
Practice Address - Country:US
Practice Address - Phone:970-223-2256
Practice Address - Fax:970-223-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-18
Last Update Date:2012-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY 2478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48353248Medicaid
C802456Medicare PIN