Healthcare Provider Details

I. General information

NPI: 1689617649
Provider Name (Legal Business Name): ANGELA D LYKINS PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA D ARTHUR PHD, HSPP

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 N BROADWAY AVE
MUNCIE IN
47303-1015
US

IV. Provider business mailing address

4221 N BROADWAY AVE
MUNCIE IN
47303-1015
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-1750
  • Fax: 765-282-9166
Mailing address:
  • Phone: 765-282-1750
  • Fax: 765-282-9166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040977
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: