Provider Demographics
NPI:1568589570
Name:CHILD PSYCHIATRY LLC
Entity Type:Organization
Organization Name:CHILD PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSHEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-626-4600
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67905-0915
Mailing Address - Country:US
Mailing Address - Phone:620-626-4600
Mailing Address - Fax:620-626-4602
Practice Address - Street 1:30 PLAZA DR
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2743
Practice Address - Country:US
Practice Address - Phone:620-626-4600
Practice Address - Fax:620-626-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-295702084P0005X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental DisabilitiesGroup - Single Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS104222OtherBCBS INDIVIDUAL
KS111102OtherBCBS GROUP
KS104222OtherBCBS INDIVIDUAL
KS111102OtherBCBS GROUP
KS111102Medicare ID - Type UnspecifiedGROUP