Provider Demographics
NPI:1942345558
Name:HUBBLE, MARALEE (MA, LMFT, LCPC)
Entity type:Individual
Prefix:
First Name:MARALEE
Middle Name:
Last Name:HUBBLE
Suffix:
Gender:F
Credentials:MA, LMFT, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 N MILWAUKEE ST STE B
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7107
Mailing Address - Country:US
Mailing Address - Phone:208-350-1616
Mailing Address - Fax:
Practice Address - Street 1:1740 N MILWAUKEE ST STE B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-7107
Practice Address - Country:US
Practice Address - Phone:208-577-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2918101YP2500X
ID3016106H00000X
IDLCPC2918101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID10140940OtherREGENCE BLUE SHIELD OF ID
IDQ4228OtherBLUE CROSS OF IDAHO