Healthcare Provider Details

I. General information

NPI: 1336219039
Provider Name (Legal Business Name): ALAN SCOTT MAUGHERMAN PH.D., HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 W ROYALE DR
MUNCIE IN
47304-2243
US

IV. Provider business mailing address

1806 W ROYALE DR
MUNCIE IN
47304-2243
US

V. Phone/Fax

Practice location:
  • Phone: 765-381-4578
  • Fax: 765-252-1316
Mailing address:
  • Phone: 765-381-4578
  • Fax: 765-252-1316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20041639A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: