Individual
BLAINE EVAN HUBBARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC, LMFT
Contact information
Practice address
827 W HARVARD ST, SILOAM SPRINGS, AR 72761-4013
(479) 549-3121
(479) 750-4843
Mailing address
2400 S 48TH ST, SPRINGDALE, AR 72762-6683
(479) 750-2020
(479) 750-4843
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P0412055
AR
106H00000X
Marriage & Family Therapist
M0502004
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5Y327
BLUE SHIELD PROVIDER #
AR
Enumeration date
06/30/2006
Last updated
07/13/2016
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