Provider Demographics
NPI:1437359494
Name:SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
Other - Org Name:SENIOR GUIDANCE, P.S.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, ACSW, CSWG
Authorized Official - Phone:812-949-2253
Mailing Address - Street 1:2831 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2075
Mailing Address - Country:US
Mailing Address - Phone:812-949-2253
Mailing Address - Fax:812-949-1335
Practice Address - Street 1:200 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3872
Practice Address - Country:US
Practice Address - Phone:502-609-0197
Practice Address - Fax:812-949-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2008-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9321041C0700X
IN340015011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY82001199Medicaid
IN201660Medicare PIN
KY82001199Medicaid
KY0767701Medicare PIN