Provider Demographics
NPI:1891457032
Name:HUBBELL, SAMANTHA KATE (MC)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:KATE
Last Name:HUBBELL
Suffix:
Gender:F
Credentials:MC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:KATE
Other - Last Name:HUBBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCI
Mailing Address - Street 1:610 SE PELTON PL
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-2078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 SW COLORADO AVE STE 220
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1635
Practice Address - Country:US
Practice Address - Phone:541-390-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR7076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health