Healthcare Provider Details

I. General information

NPI: 1164995239
Provider Name (Legal Business Name): STIPKOVITS CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 E EDGEWOOD DR STE 4
LAKELAND FL
33803-3659
US

IV. Provider business mailing address

PO BOX 6255
LAKELAND FL
33807-6255
US

V. Phone/Fax

Practice location:
  • Phone: 863-255-0297
  • Fax: 863-279-0321
Mailing address:
  • Phone: 863-213-9560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: IBOLYA STIPKOVITS
Title or Position: MANAGING MEMBER
Credential: LCSW, MSW, TIP
Phone: 863-255-0297