Provider Demographics
NPI:1952887945
Name:CHUBBUCK, PAUL ALLAN (MS, SEP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ALLAN
Last Name:CHUBBUCK
Suffix:
Gender:M
Credentials:MS, SEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3857
Mailing Address - Country:US
Mailing Address - Phone:970-493-2958
Mailing Address - Fax:
Practice Address - Street 1:1010 MORGAN ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-3857
Practice Address - Country:US
Practice Address - Phone:970-493-2958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC.0008629101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor