Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 20040086A | IN |
NPI | 1093892051 |
---|---|
Provider Name | Dr. Michael Monahan |
First Address | Martinsville, IN 46151-8773 |
Second Address | Indianapolis, IN 46227-8590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/03/2021 |