Provider Demographics
NPI:1689617649
Name:LYKINS, ANGELA D (PHD, HSPP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:D
Last Name:LYKINS
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:MISS
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:ARTHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, HSPP
Mailing Address - Street 1:4221 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-1015
Mailing Address - Country:US
Mailing Address - Phone:765-282-1750
Mailing Address - Fax:765-282-9166
Practice Address - Street 1:4221 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-1015
Practice Address - Country:US
Practice Address - Phone:765-282-1750
Practice Address - Fax:765-282-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000181482OtherANTHEM BC/BS
IN200415280Medicaid
IN084197000OtherMAGELLAN HEALTH
IN200081780Medicaid
IN200081780Medicaid