Provider Demographics
NPI:1356453922
Name:TAMMI VACHA HAASE PHD LLC
Entity Type:Organization
Organization Name:TAMMI VACHA HAASE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:VACHA-HAASE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-689-6868
Mailing Address - Street 1:1236 E ELIZABETH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4000
Mailing Address - Country:US
Mailing Address - Phone:970-488-1668
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:2553 BARRY LN
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-9366
Practice Address - Country:US
Practice Address - Phone:970-689-6868
Practice Address - Fax:970-472-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ8674OtherMEDICARE RR
CO08489521Medicaid
CO08489521Medicaid