Healthcare Provider Details

I. General information

NPI: 1083663066
Provider Name (Legal Business Name): ALTERNATIVE COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E BROADWAY ST
PRINCETON IN
47670-1843
US

IV. Provider business mailing address

403 E BROADWAY ST
PRINCETON IN
47670-1843
US

V. Phone/Fax

Practice location:
  • Phone: 812-386-7966
  • Fax: 812-386-7875
Mailing address:
  • Phone: 812-386-7966
  • Fax: 812-386-7875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003111A
License Number StateIN

VIII. Authorized Official

Name: MR. KENDALL R. NELSON
Title or Position: PARTNER
Credential: M.A., LMFT, LCSW
Phone: 812-386-7966