Provider Demographics
NPI:1467565143
Name:COUNSELING ASSOCIATES OF SOUTHERN INDIANA, PSC
Entity Type:Organization
Organization Name:COUNSELING ASSOCIATES OF SOUTHERN INDIANA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FAIRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-949-1435
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4929
Mailing Address - Country:US
Mailing Address - Phone:812-949-1435
Mailing Address - Fax:812-949-9792
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:SUITE 18
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4929
Practice Address - Country:US
Practice Address - Phone:812-949-1435
Practice Address - Fax:812-949-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty