Provider Demographics
NPI:1184127599
Name:HUBBS, NICOLE CECELIA (LMFT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:CECELIA
Last Name:HUBBS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 DENNIS LN
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4714
Mailing Address - Country:US
Mailing Address - Phone:651-402-3981
Mailing Address - Fax:
Practice Address - Street 1:220 RAILROAD ST SE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1540
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:651-925-0071
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health