Provider Demographics
NPI:1528278744
Name:KUBAT, ALVIN R (PHD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:R
Last Name:KUBAT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:AL
Other - Middle Name:
Other - Last Name:KUBAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1201 NE 7TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526
Mailing Address - Country:US
Mailing Address - Phone:541-450-5676
Mailing Address - Fax:
Practice Address - Street 1:1201 NE 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1451
Practice Address - Country:US
Practice Address - Phone:541-450-5676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6938103TB0200X
OR1979103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral