Provider Demographics
NPI:1144327883
Name:LOUGHEED, NANCEE S (PH D)
Entity type:Individual
Prefix:DR
First Name:NANCEE
Middle Name:S
Last Name:LOUGHEED
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11815 WEIGELA CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-4535
Mailing Address - Country:US
Mailing Address - Phone:260-672-1839
Mailing Address - Fax:260-673-0403
Practice Address - Street 1:2417 GETZ RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1631
Practice Address - Country:US
Practice Address - Phone:260-672-1839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000076A101YM0800X
IN34002188A1041C0700X
IN35000989A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11491775OtherCAQH
IN214800Medicare ID - Type Unspecified