Provider Demographics
NPI:1386936953
Name:STROBERG, JEFF
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:STROBERG
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 1:302 W QUANTICO ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74011-2209
Mailing Address - Country:US
Mailing Address - Phone:580-230-1470
Mailing Address - Fax:
Practice Address - Street 1:302 W QUANTICO ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74011-2209
Practice Address - Country:US
Practice Address - Phone:580-230-1470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor