Provider Demographics
NPI:1962405472
Name:SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
Entity type:Organization
Organization Name:SENIOR GUIDANCE, A PROFESSIONAL SERVICES CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-949-2253
Mailing Address - Street 1:2831 MOUNT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-2075
Mailing Address - Country:US
Mailing Address - Phone:812-949-2253
Mailing Address - Fax:812-949-1335
Practice Address - Street 1:2580 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2555
Practice Address - Country:US
Practice Address - Phone:812-949-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-30
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001501A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7677Medicare ID - Type Unspecified
S38322Medicare UPIN
IN201660AMedicare ID - Type Unspecified