Provider Demographics
NPI:1194531848
Name:JUBITZ, CORY
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:JUBITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:BINGEN
Mailing Address - State:WA
Mailing Address - Zip Code:98605-1633
Mailing Address - Country:US
Mailing Address - Phone:541-788-7305
Mailing Address - Fax:
Practice Address - Street 1:207 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BINGEN
Practice Address - State:WA
Practice Address - Zip Code:98605-9131
Practice Address - Country:US
Practice Address - Phone:541-788-7305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-07
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health