1265426472 NPI number — VICTORIA J HAAG LCMFT

Table of content: VICTORIA J HAAG LCMFT (NPI 1265426472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265426472 NPI number — VICTORIA J HAAG LCMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAAG
Provider First Name:
VICTORIA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265426472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
518 MONTANA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66436-1142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-851-4343
Provider Business Mailing Address Fax Number:
316-768-4145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 W 5TH ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66436-1788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-851-4343
Provider Business Practice Location Address Fax Number:
316-768-4145
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  102 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 481191048001 . This is a "TRICARE WEST REGION" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 6293357 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 0204835 . This is a "COMPSYCH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 14146673 . This is a "WAUSAU" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 373248 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 024436 . This is a "VMC BEHAVIORAL HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 188092 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2022246 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 200429060C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 220944 . This is a "VALUE OPTIONS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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