Individual
DR. TERESA LYNN VANNATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD HSPP
Contact information
Practice address
4607 N WHEELING AVE, MUNCIE, IN 47304
(765) 288-1110
(765) 288-4044
Mailing address
4607 N WHEELING AVE, MUNCIE, IN 47304
(765) 288-1110
(765) 288-4044
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040646A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000299448
ANTHEM BCBS
—
01
—
256942
VALUE OPTIONS
—
01
—
9999998666
MAGELLAN
—
Enumeration date
05/11/2006
Last updated
07/08/2007
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