Provider Demographics
NPI:1801581806
Name:SOBEL, MARK SAMUEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:SAMUEL
Last Name:SOBEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 W. 32ND ST.
Mailing Address - Street 2:UNIT A
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:610-247-9981
Mailing Address - Fax:
Practice Address - Street 1:1970 E. 3RD AVE OPEN SKY WILDERNESS THERAPY
Practice Address - Street 2:#205
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-759-8324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12456242-35011041C0700X
COCSW.099267451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical