Provider Demographics
NPI:1336219039
Name:MAUGHERMAN, ALAN SCOTT (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:SCOTT
Last Name:MAUGHERMAN
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 1:1806 W ROYALE DR
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2243
Mailing Address - Country:US
Mailing Address - Phone:765-381-4578
Mailing Address - Fax:765-252-1316
Practice Address - Street 1:1806 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-381-4578
Practice Address - Fax:765-252-1316
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041639A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000215914OtherBCBS
IN200199530Medicaid
IN183150Medicare ID - Type Unspecified