Provider Demographics
NPI:1316116742
Name:HUBERT, BELINDA LEWIS (PHD)
Entity type:Individual
Prefix:DR
First Name:BELINDA
Middle Name:LEWIS
Last Name:HUBERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BELINDA
Other - Middle Name:LEWIS
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17317 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9411
Mailing Address - Country:US
Mailing Address - Phone:219-696-2859
Mailing Address - Fax:219-696-1745
Practice Address - Street 1:17317 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-9411
Practice Address - Country:US
Practice Address - Phone:219-696-2859
Practice Address - Fax:219-696-1745
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INHSPP 20040912103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10465150AMedicaid
IN874180Medicare PIN