Provider Demographics
NPI:1073278883
Name:LOEBEL, GREG (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:LOEBEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 E WETMORE RD STE 117-512
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1717
Mailing Address - Country:US
Mailing Address - Phone:520-375-9055
Mailing Address - Fax:877-366-9491
Practice Address - Street 1:1961 N AVENIDA AZAHAR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-1660
Practice Address - Country:US
Practice Address - Phone:520-375-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2024-01-10
Deactivation Date:2022-02-08
Deactivation Code:
Reactivation Date:2023-05-16
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical