Provider Demographics
NPI:1528176427
Name:HARTY, MICHAEL K (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:HARTY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 LEE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1217
Mailing Address - Country:US
Mailing Address - Phone:913-341-7447
Mailing Address - Fax:913-341-7262
Practice Address - Street 1:8000 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-1217
Practice Address - Country:US
Practice Address - Phone:913-341-7447
Practice Address - Fax:913-341-7262
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP-0344103TC0700X
MOR0085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S10877Medicare UPIN
KS0008997Medicare ID - Type Unspecified