Provider Demographics
NPI:1295702033
Name:PHIPPS, HUBERTA L (LCPC)
Entity type:Individual
Prefix:
First Name:HUBERTA
Middle Name:L
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 ADDISON AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-4809
Mailing Address - Fax:208-733-0120
Practice Address - Street 1:1525 ADDISON AVE E
Practice Address - Street 2:1369 E 16TH ST
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301
Practice Address - Country:US
Practice Address - Phone:208-734-4809
Practice Address - Fax:208-733-0120
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC3421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010027562OtherBLUE SHIELD
IDQ1299OtherBLUE CROSS