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Individual

DR. WAYNE MIRACLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
ED.D. HSPP

Contact information

Practice address
413 S. LIBERTY ST., MUNCIE, IN 47305-2341
(765) 288-8586
Mailing address
413 S. LIBERTY ST., MUNCIE, IN 47305-2341
(765) 288-8586

Taxonomy

Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000186190
ANTHEM BCBS
IN
05
100333760
IN
01
112439000
MAGELLAN
IN
Enumeration date
08/17/2006
Last updated
10/18/2010
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