Provider Demographics
NPI:1720091754
Name:HUBBARD, CAROLYN (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 MEADOW RD
Mailing Address - Street 2:SUITE 272
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3768
Mailing Address - Country:US
Mailing Address - Phone:214-368-1307
Mailing Address - Fax:
Practice Address - Street 1:8350 MEADOW RD
Practice Address - Street 2:SUITE 272
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-3768
Practice Address - Country:US
Practice Address - Phone:214-368-1307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7029LCOtherBLUE CROSS/BLUE SHIELD