Provider Demographics
NPI:1801763669
Name:HUBBARD, JONATHAN TREVOR (BCBA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:TREVOR
Last Name:HUBBARD
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3513 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CATLETTSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41129-9297
Mailing Address - Country:US
Mailing Address - Phone:304-972-7629
Mailing Address - Fax:304-908-1083
Practice Address - Street 1:3513 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:CATLETTSBURG
Practice Address - State:KY
Practice Address - Zip Code:41129-9297
Practice Address - Country:US
Practice Address - Phone:304-972-7629
Practice Address - Fax:304-908-1083
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-17
Last Update Date:2025-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1-25-85084103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty