Provider Demographics
NPI:1801442090
Name:BOUBIN, CARA BETH (CADC)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:BETH
Last Name:BOUBIN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 W RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-4547
Mailing Address - Country:US
Mailing Address - Phone:319-252-4631
Mailing Address - Fax:814-212-4496
Practice Address - Street 1:1903 W RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-4547
Practice Address - Country:US
Practice Address - Phone:319-252-4631
Practice Address - Fax:814-212-4496
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)