Individual
MARY ANN NUSBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
4738 W COUNTY ROAD 400 S, LOGANSPORT, IN 46947-8371
(574) 339-9277
Mailing address
5310 WARD RD, SUITE 106, ARVADA, CO 80002-1832
(303) 278-7418
(888) 341-5050
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20042168A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20042168A
PROFESSIONAL LICENSE
IN
Enumeration date
02/15/2012
Last updated
02/15/2012
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