Provider Demographics
NPI:1437883063
Name:NUNLEY, VANDA JOANN (MATS)
Entity Type:Individual
Prefix:
First Name:VANDA
Middle Name:JOANN
Last Name:NUNLEY
Suffix:
Gender:F
Credentials:MATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:LOSANTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47354-0072
Mailing Address - Country:US
Mailing Address - Phone:765-914-6268
Mailing Address - Fax:
Practice Address - Street 1:4265 S A ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-6049
Practice Address - Country:US
Practice Address - Phone:765-962-8843
Practice Address - Fax:765-373-9918
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMATS-5153101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor