1467565143 NPI number — COUNSELING ASSOCIATES OF SOUTHERN INDIANA, PSC

Table of content: MICHELLE LEE LITTLE RDH23156 (NPI 1194699488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467565143 NPI number — COUNSELING ASSOCIATES OF SOUTHERN INDIANA, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNSELING ASSOCIATES OF SOUTHERN INDIANA, PSC
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:
1467565143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1919 STATE ST
Provider Second Line Business Mailing Address:
SUITE 18
Provider Business Mailing Address City Name:
NEW ALBANY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47150-4929
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-949-1435
Provider Business Mailing Address Fax Number:
812-949-9792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 STATE ST
Provider Second Line Business Practice Location Address:
SUITE 18
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-4929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-949-1435
Provider Business Practice Location Address Fax Number:
812-949-9792
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEARCE
Authorized Official First Name:
FAIRY
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
812-949-1435

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , 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)





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