Provider Demographics
NPI:1346663754
Name:SBOUKIS, VICKEY
Entity Type:Individual
Prefix:
First Name:VICKEY
Middle Name:
Last Name:SBOUKIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17909 SAILFISH DR
Mailing Address - Street 2:APT. C
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-7741
Mailing Address - Country:US
Mailing Address - Phone:305-310-1225
Mailing Address - Fax:
Practice Address - Street 1:207 W MORGAN ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4429
Practice Address - Country:US
Practice Address - Phone:305-310-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health