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General NPI Number Information
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NPI Number | 1770561847
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Entity Type | Organization
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Legal Business Name | THERESE C MIHLBAUER, PH.D., INC
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 4656 W JEFFERSON BLVD SUITE 200
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-969-0915
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Fax | 260-969-0917
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Provider Business Mailing Address
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Address Line | 4656 W JEFFERSON BLVD SUITE 200
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City | FORT WAYNE
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State | IN
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Zip | 46804-6857
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Country | US
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Telephone | 260-969-0915
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Fax | 260-969-0917
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Authorized Official
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Title or Position | CEO
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Name | THERESE C MIHLBAUER
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Credential | PH.D.
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Telephone | 260-969-0915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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