Individual
THERESE C MIHLBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
2712 S CALHOUN ST, FORT WAYNE, IN 46807-1402
(260) 744-4326
(260) 744-0188
Mailing address
2712 S. CALHOUN STREET, FORT WAYNE, IN 46807-1402
(260) 744-4326
(260) 744-0188
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20010502A
IN
103TC1900X
Counseling Psychologist
Primary
20010502A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081280
—
IN
05
—
200730270
—
IN
Enumeration date
08/17/2005
Last updated
06/13/2017
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