Individual
GREGORY SCOTT SOWLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP LMHC PHD
Contact information
Practice address
10315 DAWSONS CREEK BLVD STE E, FORT WAYNE, IN 46825-1912
(260) 387-6340
(260) 387-6984
Mailing address
10315 DAWSONS CREEK BLVD STE E, FORT WAYNE, IN 46825-1912
(260) 387-6340
(260) 387-6984
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001155
IN
103G00000X
Clinical Neuropsychologist
Primary
20040656
IN
103TF0200X
Forensic Psychologist
20040656
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200380270
—
IN
01
—
200905570A
MEDICAID VISION' GROUP NO.
IN
01
—
258620
VISION MEDICARE GROUP NO
IN
Enumeration date
08/14/2006
Last updated
05/29/2013
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