Healthcare Provider Details

I. General information

NPI: 1063863629
Provider Name (Legal Business Name): GREGORY OBERT PH.D., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 PROFESSIONAL PKWY STE 101
HATTIESBURG MS
39402-2648
US

IV. Provider business mailing address

106 COVINGTON CT
RIDGELAND MS
39157-8706
US

V. Phone/Fax

Practice location:
  • Phone: 872-213-5546
  • Fax:
Mailing address:
  • Phone: 601-809-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180013378
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number641183
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: