Provider Demographics
NPI:1528163672
Name:OBERLIN, KAREN SUE (MFT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:OBERLIN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E AIRPORT DRIVE
Mailing Address - Street 2:#230
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3427
Mailing Address - Country:US
Mailing Address - Phone:909-383-7100
Mailing Address - Fax:
Practice Address - Street 1:202 E AIRPORT DR STE 230
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408
Practice Address - Country:US
Practice Address - Phone:909-383-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist