Provider Demographics
NPI:1013632363
Name:RUBIO, DEVAN KRISTINE (LPCC)
Entity Type:Individual
Prefix:
First Name:DEVAN
Middle Name:KRISTINE
Last Name:RUBIO
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:DEVAN
Other - Middle Name:KRISTINE
Other - Last Name:ANDRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1772 STIEGER LAKE LN
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-7723
Mailing Address - Country:US
Mailing Address - Phone:952-443-4600
Mailing Address - Fax:952-443-4604
Practice Address - Street 1:1120 WAYZATA BLVD E STE 210
Practice Address - Street 2:
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391-1984
Practice Address - Country:US
Practice Address - Phone:952-443-4600
Practice Address - Fax:952-443-4604
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC03264101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health