Healthcare Provider Details

I. General information

NPI: 1134118276
Provider Name (Legal Business Name): SOUTHERN HILLS COUNSELING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 EVERSMAN DR
JASPER IN
47546-3548
US

IV. Provider business mailing address

PO BOX 769
JASPER IN
47547-0769
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-3020
  • Fax: 812-482-6409
Mailing address:
  • Phone: 812-482-3020
  • Fax: 812-482-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD KENT WHITAKER JR.
Title or Position: ASSOCIATE DIRECTOR/CFO
Credential: PH. D.
Phone: 812-482-3020