Provider Demographics
NPI:1962655969
Name:ENGBERG, JEFFREY ALLEN (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ALLEN
Last Name:ENGBERG
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 THE EXCHANGE SE
Mailing Address - Street 2:SUITE 650
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2065
Mailing Address - Country:US
Mailing Address - Phone:770-541-1114
Mailing Address - Fax:770-541-1116
Practice Address - Street 1:1820 THE EXCHANGE SE
Practice Address - Street 2:SUITE 650
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-2065
Practice Address - Country:US
Practice Address - Phone:770-541-1114
Practice Address - Fax:770-541-1116
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFTOOO875106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist