Provider Demographics
NPI:1225901713
Name:CHUBB, MARK C
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:CHUBB
Suffix:
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 1:4600 W 90TH TER STE 101
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2348
Mailing Address - Country:US
Mailing Address - Phone:913-444-2268
Mailing Address - Fax:
Practice Address - Street 1:4600 W 90TH TER STE 101
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2348
Practice Address - Country:US
Practice Address - Phone:913-444-2268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-29
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC05207T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health