Provider Demographics
NPI:1982984225
Name:LUBS EAGLE, KRISTIN NICOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:NICOLE
Last Name:LUBS EAGLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:NICOLE
Other - Last Name:LUBS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:5677 POTAWATOMI CT
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8729
Mailing Address - Country:US
Mailing Address - Phone:989-390-9991
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1876
Practice Address - Country:US
Practice Address - Phone:989-390-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012646101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor