Provider Demographics
NPI:1225358229
Name:LOBERG, MARTIN JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:JOHN
Last Name:LOBERG
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 SONOMA PARK DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2091
Mailing Address - Country:US
Mailing Address - Phone:405-246-5433
Mailing Address - Fax:405-562-1451
Practice Address - Street 1:16301 SONOMA PARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5498
Practice Address - Country:US
Practice Address - Phone:405-246-5433
Practice Address - Fax:405-562-1451
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63169101YP2500X
OK4377101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional