Provider Demographics
NPI:1336247576
Name:HUBBARD, TERESA DARLENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:DARLENE
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 POTEET ST
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-4231
Mailing Address - Country:US
Mailing Address - Phone:318-286-1782
Mailing Address - Fax:
Practice Address - Street 1:900 8TH ST STE 304
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6804
Practice Address - Country:US
Practice Address - Phone:318-286-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC57741041C0700X
LA42951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2061152Medicaid