Provider Demographics
NPI:1528757408
Name:UBBEN, KATIE LYN (MS, LAC)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LYN
Last Name:UBBEN
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 W FINANCIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-1471
Mailing Address - Country:US
Mailing Address - Phone:479-986-8655
Mailing Address - Fax:
Practice Address - Street 1:3901 W FINANCIAL PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-1471
Practice Address - Country:US
Practice Address - Phone:479-986-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1308089101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health