Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073278883 |
---|---|
Provider Name | Greg Loebel |
First Address | Tucson, AZ 85745-1660 |
Second Address | Tucson, AZ 85716-4756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2021 |
Last Update Date | 05/11/2021 |