Provider Demographics
NPI:1124810106
Name:HUBBARD, LATIFA LYNEZ
Entity type:Individual
Prefix:
First Name:LATIFA
Middle Name:LYNEZ
Last Name:HUBBARD
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 1:2519 WASHINGTON ST APT 203
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-8677
Mailing Address - Country:US
Mailing Address - Phone:281-757-3237
Mailing Address - Fax:
Practice Address - Street 1:3641 ACORN DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-0162
Practice Address - Country:US
Practice Address - Phone:972-896-5083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician