MEDICARE: SDS COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1689138794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SDS COUNSELING LLC

Provider Business Mailing Address
First Line	:	590 MISSOURI AVENUE
Second Line	:	SUITE 206-F
City	:	JEFFERSONVILLE, INDIANA
State	:	IN
Zip	:	47130
Country	:	US
Telephone Number	:	812-406-6276
Fax Number	:	812-748-5084

Provider Business Practice Location Address
First Line	:	590 MISSOURI AVE STE 206F
Second Line	:
City	:	JEFFERSONVILLE
State	:	IN
Zip	:	47130-3084
Country	:	US
Telephone Number	:	812-406-6276
Fax Number	:	812-748-5084

Authorized Official
Title or Position	:	THERAPIST
Name	:	SHERRY DEHN-SMITH
Credential	:	LCSW
Telephone Number	:	812-406-6276

Provider Enumeration Date	:	01/23/2019
Last Update Date	:	01/23/2019

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