Provider Demographics
NPI:1396285417
Name:HUBBARD, STEPHANIE JANN
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JANN
Last Name:HUBBARD
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 1:519 N LA CIENEGA BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2007
Mailing Address - Country:US
Mailing Address - Phone:323-505-2638
Mailing Address - Fax:
Practice Address - Street 1:519 N LA CIENEGA BLVD STE 209
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-2007
Practice Address - Country:US
Practice Address - Phone:323-505-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-08
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT12977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist