Organization
THERESE C MIHLBAUER, PH.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESE C MIHLBAUER PH.D. (CEO)
(260) 969-0915
Entity
Organization
Contact information
Practice address
4656 W JEFFERSON BLVD, SUITE 200, FORT WAYNE, IN 46804-6857
(260) 969-0915
(260) 969-0917
Mailing address
4656 W JEFFERSON BLVD, SUITE 200, FORT WAYNE, IN 46804-6857
(260) 969-0915
(260) 969-0917
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100081280
—
IN
05
—
200667860
—
IN
05
—
200730270
—
IN
Enumeration date
01/09/2006
Last updated
01/05/2011
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