Provider Demographics
NPI:1871226068
Name:SOWKA PSYCHOTHERAPY & CONSULTATION LLC
Entity type:Organization
Organization Name:SOWKA PSYCHOTHERAPY & CONSULTATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:SOWKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, MCAP
Authorized Official - Phone:352-577-9455
Mailing Address - Street 1:321 W ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3205
Mailing Address - Country:US
Mailing Address - Phone:352-577-9455
Mailing Address - Fax:352-604-4375
Practice Address - Street 1:321 W ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3205
Practice Address - Country:US
Practice Address - Phone:352-577-9455
Practice Address - Fax:352-604-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10742500Medicaid
FL114905900Medicaid