MEDICARE: JASON CARL SOPKOVICH LPC LICDC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LICDC.162769	OH
2	101YP2500X	Professional Counselor	C.2506972	OH
3	101YM0800X	Mental Health Counselor	C.2506972	OH
4	101Y00000X	Counselor	C.2506972	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881194405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON CARL SOPKOVICH LPC LICDC

Provider Business Mailing Address
First Line	:	7801 DAY DR UNIT 29054
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44129-5656
Country	:	US
Telephone Number	:	216-323-9538
Fax Number	:	216-270-7347

Provider Business Practice Location Address
First Line	:	7055 ENGLE RD # 6-601
Second Line	:
City	:	MIDDLEBURG HEIGHTS
State	:	OH
Zip	:	44130-8491
Country	:	US
Telephone Number	:	216-232-9538
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	01/05/2026

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