Provider Demographics
NPI:1932887908
Name:HUBER, STEPHEN LAWRENCE JR
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:HUBER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 PLEASANT GROVE DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-6153
Mailing Address - Country:US
Mailing Address - Phone:407-782-3625
Mailing Address - Fax:
Practice Address - Street 1:556 PLEASANT GROVE DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-6153
Practice Address - Country:US
Practice Address - Phone:407-782-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health