Provider Demographics
NPI:1801948062
Name:ASSOCIATES IN COUNSELING AND PSYCHOTHERAPY
Entity type:Organization
Organization Name:ASSOCIATES IN COUNSELING AND PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL SUPV
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:812-944-1550
Mailing Address - Street 1:2627 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2536
Mailing Address - Country:US
Mailing Address - Phone:812-944-1550
Mailing Address - Fax:812-725-7865
Practice Address - Street 1:2627 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2536
Practice Address - Country:US
Practice Address - Phone:812-944-1550
Practice Address - Fax:812-725-7865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005077A1041C0700X
IN20041227A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200542700AMedicaid