Provider Demographics
NPI:1780727040
Name:LOEB, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:LOEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 S HARVARD AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-3071
Mailing Address - Country:US
Mailing Address - Phone:918-748-9868
Mailing Address - Fax:918-748-9835
Practice Address - Street 1:4720 S HARVARD AVE STE 207
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-3071
Practice Address - Country:US
Practice Address - Phone:918-748-9868
Practice Address - Fax:918-748-9835
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1126101YP2500X
OK168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist