| Willow Branch Counseling | |
|
1806 W Royale Dr Muncie IN 47304-2243 | |
| (765) 755-0052 | |
| (765) 755-0052 |
| Full Name | Willow Branch Counseling |
|---|---|
| Speciality | Psychologist |
| Location | 1806 W Royale Dr, Muncie, Indiana |
| Authorized Official Name and Position | Grace Kimmerling (PRESIDENT) |
| Authorized Official Contact | 7657550052 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Branch Counseling 1806 W Royale Dr Muncie IN 47304-2243 Ph: (765) 755-0052 | Willow Branch Counseling 1806 W Royale Dr Muncie IN 47304-2243 Ph: (765) 755-0052 |
| NPI Number | 1962659607 |
|---|---|
| Provider Enumeration Date | 08/25/2008 |
| Last Update Date | 03/06/2023 |
| Certification Date | 03/06/2023 |
| Medicare PECOS PAC ID | 3779646203 |
|---|---|
| Medicare Enrollment ID | O20090109000515 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962659607 | NPI | - | NPPES |
| 200911770A | Medicaid | IN | |
| 11646258 | Other | IN | CAQH |
| 000000588248 | Other | IN | ANTHEM BC/BS PIN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20041639A (Indiana) | Primary |
| Provider Name | Alan Maugherman |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336219039 PECOS PAC ID: 9234292756 Enrollment ID: I20090109000503 |
| Provider Name | Kristin Perrone-mcgovern |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083759336 PECOS PAC ID: 9830361740 Enrollment ID: I20111018000473 |
| Provider Name | Michael L Miller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1154393031 PECOS PAC ID: 0446482236 Enrollment ID: I20140409001596 |
| Provider Name | Rachel H Gentry |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1326221169 PECOS PAC ID: 8820356934 Enrollment ID: I20171219002154 |
| Provider Name | Grace M Kimmerling |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1942871306 PECOS PAC ID: 7517355464 Enrollment ID: I20211026000233 |
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