Provider Demographics
NPI:1528710076
Name:CHUBB, KAROL LYNN
Entity type:Individual
Prefix:
First Name:KAROL
Middle Name:LYNN
Last Name:CHUBB
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 1:1048 DUQUESA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ISABELLA
Mailing Address - State:MI
Mailing Address - Zip Code:48893-9392
Mailing Address - Country:US
Mailing Address - Phone:810-986-1780
Mailing Address - Fax:
Practice Address - Street 1:1048 DUQUESA DR
Practice Address - Street 2:
Practice Address - City:LAKE ISABELLA
Practice Address - State:MI
Practice Address - Zip Code:48893-9392
Practice Address - Country:US
Practice Address - Phone:810-986-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-25
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101007413106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist