NPIMap

Organization Active NPI

Therese C Mihlbauer, PH.D., Inc

  • Psychologist
  • Fort Wayne, IN
National Provider Identifier
1770561847
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
THERESE C MIHLBAUER, PH.D., INC
Practice address
4656 W Jefferson Blvd
Suite 200
Fort Wayne, IN 46804-6857
Phone
(260) 969-0915
Fax
(260) 969-0917
NPI assigned
Jan 9, 2006
Last updated
Jan 5, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Therese C Mihlbauer, PH.D.
Title
Ceo
Phone
(260) 969-0915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X Primary

Addresses

Primary practice location

4656 W Jefferson Blvd
Suite 200
Fort Wayne, IN 46804-6857

Mailing address

4656 W Jefferson Blvd
Suite 200
Fort Wayne, IN 46804-6857
Phone (260) 969-0915

Other identifiers 3

IdentifierTypeStateIssuer
100081280MedicaidIN
200730270MedicaidIN
200667860MedicaidIN

National Provider Directory

National Provider Directory

Locations

4656 W Jefferson Blvd
Ste 200
Fort Wayne, IN 46804
Phone (260) 969-0915

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1770561847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "SUITE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857",
            "telephone_number": "260-969-0915",
            "fax_number": "260-969-0917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4656 W JEFFERSON BLVD",
            "address_2": "SUITE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046857",
            "telephone_number": "260-969-0915",
            "fax_number": "260-969-0917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERESE C MIHLBAUER, PH.D., INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "MIHLBAUER",
        "authorized_official_first_name": "THERESE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "260-969-0915",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100081280",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200730270",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200667860",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.