Basic Information
Provider Information
NPI: 1033558721
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOSBEE
FirstName: GARY
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1331
Address2:  
City: BELTON
State: TX
PostalCode: 765135331
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2201 S W S YOUNG DR STE 116B
Address2:  
City: KILLEEN
State: TX
PostalCode: 765435349
CountryCode: US
TelephoneNumber: 2546342212
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/17/2013
LastUpdateDate: 06/17/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X66632TXY Behavioral Health & Social Service ProvidersCounselor 
101YA0400X11043TXN Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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