Provider Demographics
NPI:1245364983
Name:HUBER, MARK (MS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:HUBER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 N US HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-0726
Mailing Address - Country:US
Mailing Address - Phone:608-757-5215
Mailing Address - Fax:
Practice Address - Street 1:1051 NANTUCKET DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53546-1763
Practice Address - Country:US
Practice Address - Phone:608-752-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2519-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2519-123OtherCLINICAL SOCIAL WORKER
WI1137-125OtherLPC