Provider Demographics
NPI:1477786010
Name:SOKOL, JUSTIN TYLER (BS)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:TYLER
Last Name:SOKOL
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 N 15TH ST # 171A
Mailing Address - Street 2:SCHROEDER COMPLEX
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53233-2237
Mailing Address - Country:US
Mailing Address - Phone:414-288-4556
Mailing Address - Fax:
Practice Address - Street 1:561 N 15TH ST # 171A
Practice Address - Street 2:SCHROEDER COMPLEX
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2237
Practice Address - Country:US
Practice Address - Phone:414-288-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)