Provider Demographics
NPI:1679873632
Name:SUHUBA-BARUTI, HASANI (LLPC)
Entity type:Individual
Prefix:MR
First Name:HASANI
Middle Name:
Last Name:SUHUBA-BARUTI
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:CARLOS
Other - Middle Name:RANALDO
Other - Last Name:CULLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3163 EDLING DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49004-1150
Mailing Address - Country:US
Mailing Address - Phone:269-226-2686
Mailing Address - Fax:269-323-4183
Practice Address - Street 1:5805 OAKLAND DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-1118
Practice Address - Country:US
Practice Address - Phone:269-323-1954
Practice Address - Fax:269-323-4183
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012106101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional