Individual
DR. ALAN H WAX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD HSPP
Contact information
Practice address
113 LINCOLNWAY E, MISHAWAKA, IN 46544-2016
(574) 255-1162
(574) 255-1882
Mailing address
113 LINCOLNWAY E, MISHAWAKA, IN 46544-2016
(574) 255-1162
(574) 255-1882
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040447A
IN
103TC0700X
Clinical Psychologist
Primary
20040447A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000368604
ANTHEM
IN
05
—
200021670
—
IN
Enumeration date
11/13/2006
Last updated
05/31/2017
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