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NPI Code Detail

MEDICARE: THERESE C MIHLBAUER PH.D

MEDICARE: THERESE C MIHLBAUER PH.D
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
1103T00000XPsychologist20010502AIN
2103TC1900XCounseling Psychologist20010502AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609868504
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESE C MIHLBAUER PH.D
Provider Business Mailing Address
First Line : 2712 S. CALHOUN STREET
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Provider Business Practice Location Address
First Line : 2712 S CALHOUN ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46807-1402
Country : US
Telephone Number : 260-744-4326
Fax Number : 260-744-0188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 06/13/2017

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