Provider Demographics
NPI:1083062400
Name:SOBCZAK, KELLY (LMHC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SOBCZAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 E CENTER ST STE B4B
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-2852
Mailing Address - Country:US
Mailing Address - Phone:574-337-3114
Mailing Address - Fax:574-800-4646
Practice Address - Street 1:119 E CENTER ST STE B4B
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-2852
Practice Address - Country:US
Practice Address - Phone:574-337-3114
Practice Address - Fax:574-800-4646
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300057534Medicaid