Provider Demographics
NPI:1902624182
Name:BUBULA, ARDEN DANIEL (LPC-IT)
Entity type:Individual
Prefix:
First Name:ARDEN
Middle Name:DANIEL
Last Name:BUBULA
Suffix:
Gender:X
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:742 BEAR CLAW WAY APT 308
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-2775
Mailing Address - Country:US
Mailing Address - Phone:847-340-0422
Mailing Address - Fax:
Practice Address - Street 1:742 BEAR CLAW WAY APT 308
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-2775
Practice Address - Country:US
Practice Address - Phone:847-340-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8016-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health