Provider Demographics
NPI:1699596502
Name:PHEGLEY, VIRGINIA (GINNY) DARLENE
Entity type:Individual
Prefix:MS
First Name:VIRGINIA (GINNY)
Middle Name:DARLENE
Last Name:PHEGLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 A ST NE
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1838
Mailing Address - Country:US
Mailing Address - Phone:812-268-6757
Mailing Address - Fax:
Practice Address - Street 1:415 W FRAKES ST
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7512
Practice Address - Country:US
Practice Address - Phone:812-268-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN663486103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool