Provider Demographics
NPI:1073122255
Name:SOWKA, MELINDA MAY (LMHC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:MAY
Last Name:SOWKA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W ALFRED ST
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-3205
Mailing Address - Country:US
Mailing Address - Phone:352-577-9455
Mailing Address - Fax:352-604-4375
Practice Address - Street 1:321 W ALFRED ST
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-3205
Practice Address - Country:US
Practice Address - Phone:352-577-9455
Practice Address - Fax:352-604-4375
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18228101YM0800X
FLLMHC18228101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114905900Medicaid