Provider Demographics
NPI:1194895953
Name:ALTMAN & HAAVIK PA
Entity type:Organization
Organization Name:ALTMAN & HAAVIK PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:I
Authorized Official - Last Name:ALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:785-331-4100
Mailing Address - Street 1:1711 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-4257
Mailing Address - Country:US
Mailing Address - Phone:785-331-3400
Mailing Address - Fax:785-842-6007
Practice Address - Street 1:1711 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-4257
Practice Address - Country:US
Practice Address - Phone:785-331-3400
Practice Address - Fax:785-842-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP0290103TC0700X
KSLP0695103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS066807Medicare ID - Type UnspecifiedDR ALTMAN
KS060806Medicare ID - Type UnspecifiedDR HAAVIK