Provider Demographics
NPI:1609059146
Name:VISION COUNSELING AND PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:VISION COUNSELING AND PSYCHOLOGICAL SERVICES, PC
Other - Org Name:VISION COUNSELING AND PSYCHOLOGICAL SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PSYCHOLOGIST /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:HSPP LMHC PHD
Authorized Official - Phone:260-387-6340
Mailing Address - Street 1:10315 DAWSONS CREEK BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1912
Mailing Address - Country:US
Mailing Address - Phone:260-387-6340
Mailing Address - Fax:260-387-6984
Practice Address - Street 1:10315 DAWSONS CREEK BLVD STE E
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1912
Practice Address - Country:US
Practice Address - Phone:260-387-6340
Practice Address - Fax:260-387-6984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258620AOtherMEDICARE PIN G.SOWLES
IN202100AOtherMEDICARE PIN
IN200905570AOtherMEDICAID VISION' GROUP PIN
IN202100AOtherMEDICARE PIN
IN200905570AOtherMEDICAID VISION' GROUP PIN
IN139770AMedicare PIN