Provider Demographics
NPI:1427624972
Name:FUBLER, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:FUBLER
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 1:1856 SURREY TRL
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-2725
Mailing Address - Country:US
Mailing Address - Phone:937-499-4419
Mailing Address - Fax:
Practice Address - Street 1:1856 SURREY TRL
Practice Address - Street 2:
Practice Address - City:BELLBROOK
Practice Address - State:OH
Practice Address - Zip Code:45305-2725
Practice Address - Country:US
Practice Address - Phone:937-499-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor