Provider Demographics
NPI:1457487944
Name:V. THOMAS MAWHINNEY, PH.D., INC.
Entity Type:Organization
Organization Name:V. THOMAS MAWHINNEY, PH.D., INC.
Other - Org Name:BEHAVIORAL PSYCHOLOGICAL FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MAWHINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:574-251-1531
Mailing Address - Street 1:828 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2804
Mailing Address - Country:US
Mailing Address - Phone:574-251-1531
Mailing Address - Fax:574-234-5710
Practice Address - Street 1:828 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2804
Practice Address - Country:US
Practice Address - Phone:574-251-1531
Practice Address - Fax:574-234-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN735890Medicare ID - Type Unspecified
IN168180Medicare ID - Type Unspecified