Provider Demographics
NPI:1679776694
Name:ROSS MOBERG, KENNETH WALTER (LCMFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:WALTER
Last Name:ROSS MOBERG
Suffix:
Gender:M
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:LINDSBORG
Mailing Address - State:KS
Mailing Address - Zip Code:67456-5156
Mailing Address - Country:US
Mailing Address - Phone:785-342-3693
Mailing Address - Fax:
Practice Address - Street 1:134 S SANTE FE
Practice Address - Street 2:STE 130
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-342-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist