Provider Demographics
NPI:1215480850
Name:HUBEN, CASEY DYCKMAN
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:DYCKMAN
Last Name:HUBEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CASEY
Other - Middle Name:
Other - Last Name:DYCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16130 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE BALBOA
Mailing Address - State:CA
Mailing Address - Zip Code:91406-3907
Mailing Address - Country:US
Mailing Address - Phone:424-262-3451
Mailing Address - Fax:
Practice Address - Street 1:16130 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:LAKE BALBOA
Practice Address - State:CA
Practice Address - Zip Code:91406-3907
Practice Address - Country:US
Practice Address - Phone:818-285-8252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst