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General NPI Number Information
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NPI Number | 1376032979
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Entity Type | Individual
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Provider Name | SUSANNE SOGAR
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Gender | Female
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 2734 OAK RIDGE CT STE 404
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City | FORT MYERS
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State | FL
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Zip | 33901-9369
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Country | US
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Telephone | 239-963-4367
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Fax |
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Provider Business Mailing Address
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Address Line | 251 ALBATROSS ST
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City | FORT MYERS BEACH
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State | FL
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Zip | 33931-4503
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Country | US
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Telephone | 214-843-4826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15902
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License Number State | FL
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