Provider Demographics
NPI:1275684508
Name:SPENGLER, PAUL MANFRED (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MANFRED
Last Name:SPENGLER
Suffix:
Gender:M
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2265
Mailing Address - Country:US
Mailing Address - Phone:765-288-7939
Mailing Address - Fax:765-288-7841
Practice Address - Street 1:1945 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2265
Practice Address - Country:US
Practice Address - Phone:765-288-7939
Practice Address - Fax:765-288-7841
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040707A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100333770BMedicaid
IN000000330991OtherBLUE CROSS BLUE SHIELD
IN100333770BMedicaid