Provider Demographics
NPI:1134348782
Name:HUBBLE, GLORIA J (MS)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:J
Last Name:HUBBLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ARELLANO CT
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-9344
Mailing Address - Country:US
Mailing Address - Phone:530-668-5874
Mailing Address - Fax:
Practice Address - Street 1:3000 AUBURN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-1831
Practice Address - Country:US
Practice Address - Phone:916-483-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist