1972710481 NPI number — NOVA COUNSELING ALTERNATIVES LLC

Table of content: (NPI 1972710481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972710481 NPI number — NOVA COUNSELING ALTERNATIVES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA COUNSELING ALTERNATIVES LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972710481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47151-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-206-3291
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1941 E SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-206-3291
Provider Business Practice Location Address Fax Number:
812-206-3296
Provider Enumeration Date:
05/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WISMAN
Authorized Official First Name:
SELENA
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-206-3291

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34004562A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 1042 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34003588A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 35001423A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11459548 . This is a "WENDY CAQH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 11608101 . This is a "CAQH E. HATFIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1477559334 . This is a "NPI WENDY WILLIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11459226 . This is a "CAQH S. WISMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1316944432 . This is a "NPI SELENA WISMAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: IN2168 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1467459446 . This is a "NPI-ELENA HATFIELD" identifier . This identifiers is of the category "OTHER".