Provider Demographics
NPI:1154212827
Name:HUBER, MARK G
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:HUBER
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 WHITE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-6606
Mailing Address - Country:US
Mailing Address - Phone:208-597-3292
Mailing Address - Fax:
Practice Address - Street 1:428 WHITE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-6606
Practice Address - Country:US
Practice Address - Phone:208-597-3292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCFH-3764253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency