Provider Demographics
NPI:1497711618
Name:SOKUP, MARY K (LMF)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SOKUP
Suffix:
Gender:F
Credentials:LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4455
Mailing Address - Country:US
Mailing Address - Phone:715-832-5454
Mailing Address - Fax:715-832-2991
Practice Address - Street 1:2005 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4455
Practice Address - Country:US
Practice Address - Phone:715-832-5454
Practice Address - Fax:715-832-2991
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI560124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6275964OtherUBH
MN6275964OtherMEDICA
MN637871026344OtherPRESBYTERIAN HEALTH PLAN
MN8H016SOOtherBCBS MN
MN6275964OtherUHC
WI39777400Medicaid
WI54161OtherSECURITY HEALTH PLAN