Provider Demographics
NPI:1962478701
Name:HUBBARD, MICHAEL LAWRENCE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10888 BELL STATION RD
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42262-9372
Mailing Address - Country:US
Mailing Address - Phone:270-439-1934
Mailing Address - Fax:
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223
Practice Address - Country:US
Practice Address - Phone:270-798-8601
Practice Address - Fax:270-798-8239
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical