Provider Demographics
NPI:1689338071
Name:REFUGE COUNSELING AND CONSULTING LLC
Entity Type:Organization
Organization Name:REFUGE COUNSELING AND CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:SOBCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:574-337-3114
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300057534Medicaid