Provider Demographics
NPI:1104350388
Name:SOLBERG, THERESA LYNNETTE (LPC-CANDIDATE)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNNETTE
Last Name:SOLBERG
Suffix:
Gender:F
Credentials:LPC-CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-2111
Mailing Address - Country:US
Mailing Address - Phone:405-535-7055
Mailing Address - Fax:
Practice Address - Street 1:4835 S FULTON AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-6995
Practice Address - Country:US
Practice Address - Phone:918-712-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor