Provider Demographics
NPI:1972710481
Name:NOVA COUNSELING ALTERNATIVES LLC
Entity Type:Organization
Organization Name:NOVA COUNSELING ALTERNATIVES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SELENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:812-206-3291
Mailing Address - Street 1:PO BOX 413
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47151-0413
Mailing Address - Country:US
Mailing Address - Phone:812-206-3291
Mailing Address - Fax:
Practice Address - Street 1:1941 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-1658
Practice Address - Country:US
Practice Address - Phone:812-206-3291
Practice Address - Fax:812-206-3296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004562A1041C0700X
KY10421041C0700X, 1041C0700X
IN34003588A1041C0700X
IN35001423A106H00000X, 106H00000X
KY0271106H00000X
KY0470106H00000X
IN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11459548OtherWENDY CAQH
11608101OtherCAQH E. HATFIELD
1477559334OtherNPI WENDY WILLIS
11459226OtherCAQH S. WISMAN
1316944432OtherNPI SELENA WISMAN
ININ2168OtherMEDICARE PTAN
1467459446OtherNPI-ELENA HATFIELD
1376540492OtherNPI CATHERINE CAUSEY
11385715OtherCAQH C. CAUSEY
1316944432OtherNPI SELENA WISMAN
KY1477559334Medicare ID - Type UnspecifiedWENDY WILLIS, LCSW
INP00331414Medicare ID - Type UnspecifiedIN RR - WENDY WILLIS LCSW
KY82000514Medicaid
1477559334OtherNPI WENDY WILLIS