Provider Demographics
NPI:1396326526
Name:HUBBELL, LEE (BA, MED, MDIV, MA)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:HUBBELL
Suffix:
Gender:M
Credentials:BA, MED, MDIV, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6963 N SHERIDAN RD APT 1N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-5258
Mailing Address - Country:US
Mailing Address - Phone:773-517-3865
Mailing Address - Fax:
Practice Address - Street 1:6963 N SHERIDAN RD APT 1N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-5258
Practice Address - Country:US
Practice Address - Phone:773-517-3865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.009956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional