Provider Demographics
NPI:1144371733
Name:MAWHINNEY, VAUGHN THOMAS (PHD)
Entity type:Individual
Prefix:
First Name:VAUGHN
Middle Name:THOMAS
Last Name:MAWHINNEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:V.
Other - Middle Name:THOMAS
Other - Last Name:MAWHINNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20090171103TC1900X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN735890EMedicare ID - Type Unspecified