Provider Demographics
NPI:1457648768
Name:OBERT, SYLVIA CRISTINA (MA)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:CRISTINA
Last Name:OBERT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:CRISTINA
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10414 205TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-8815
Mailing Address - Country:US
Mailing Address - Phone:616-558-3725
Mailing Address - Fax:
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-456-8010
Practice Address - Fax:616-456-6396
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014826103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling