Alan H Wax, PHD HSPP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

20040447A Issued in IN

Practice address

113 Lincolnway E
Mishawaka, IN 46544-2016

Phone

(574) 255-1162

Fax

(574) 255-1882

NPI assigned

Nov 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24035/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Bend Mental Health Associates, PC

  • Psychologist
  • Mishawaka, IN
  • NPI 1740489939
  NPD (past) Authorized official
• Psych Pointe LLC

  • Community/Behavioral Health Agency
  • Mishawaka, IN
  • NPI 1861087355
  NPD (past)

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1851462451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LINCOLNWAY E",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442016",
            "telephone_number": "574-255-1162",
            "fax_number": "574-255-1882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LINCOLNWAY E",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465442016",
            "telephone_number": "574-255-1162",
            "fax_number": "574-255-1882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAX",
        "first_name": "ALAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "PHD HSPP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040447A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20040447A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200021670",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000368604",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shea Lee Warner
• Janelle Warrell
• Susan Marie Wassenhove, PA-C
• Kathye J Waters, LMHC
• Tosha E Watkins, MNT
• Chana Wax, CCC-SLP
• Rozi P Wax, LMHC
• Judith A. Weaver-Yoder, CNM
• Ekaterina Sue Weaver, NP
• Leroy D Weaver Jr., MD

• Clinical Psychologist in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Clinical Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.