1902043524

Everything you always wanted to know about MS. BUBAR MYRA MARLENE MARLENE BUBAR 1 MISS MARTIN MYRA MARLENE MARLENE BUBAR, LCSW but were afraid to ask.

MS. BUBAR MYRA MARLENE MARLENE BUBAR 1 MISS MARTIN MYRA MARLENE MARLENE BUBAR, LCSW

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Provider Prefix Provider Last Name Provider Middle Name Provider First Name Provider Credential Provider Other Name Type Code Provider Other Name Prefix Provider Other Last Name Provider Other Middle Name Provider Other First Name Provider Other Credential
MS. BUBAR MYRA MARLENE MARLENE BUBAR 1 MISS MARTIN MYRA MARLENE MARLENE BUBAR, LCSW
Gender:
Female
Enumeration date:
2009-01-20
Last update date:
2009-01-20
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
No
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
1041C0700X Clinical ID LCSW-557 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 2085244937
Practice Location Address Telephone Number 2085244937

Addresses

Type Address City State Postal Country
Mailing Address 722 NORVIN AVE IDAHO FALLS ID 83401 ID
Practice Location Address 722 NORVIN AVE IDAHO FALLS ID 83401 ID