Provider Demographics
NPI:1801447776
Name:LOBERG, LAUREN ALINE (PHD, LCMHC)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALINE
Last Name:LOBERG
Suffix:
Gender:F
Credentials:PHD, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 683891
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84068-3891
Mailing Address - Country:US
Mailing Address - Phone:435-901-0071
Mailing Address - Fax:
Practice Address - Street 1:10 TRAILSIDE CT
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7435
Practice Address - Country:US
Practice Address - Phone:435-901-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7882357-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health