Provider Demographics
NPI:1972351682
Name:OBERG, AMY (MS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:OBERG
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3464 S BRANDING IRON LN
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8413
Mailing Address - Country:US
Mailing Address - Phone:928-727-9002
Mailing Address - Fax:
Practice Address - Street 1:119 WALNUT ST
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-5638
Practice Address - Country:US
Practice Address - Phone:928-331-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral