Provider Demographics
NPI:1689625832
Name:NUNN, WILLIAM (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:NUNN
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:PO BOX 4323
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47804-0323
Mailing Address - Country:US
Mailing Address - Phone:812-231-8323
Mailing Address - Fax:812-231-8400
Practice Address - Street 1:239 HILLSDALE AVE
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-1340
Practice Address - Country:US
Practice Address - Phone:765-653-1024
Practice Address - Fax:765-653-4931
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041024103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200067860Medicaid
IN200067860Medicaid