Provider Demographics
NPI:1780268946
Name:HEARTLAND PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:HEARTLAND PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LAGRANGE-AULICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCP, LMLP
Authorized Official - Phone:785-770-5225
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66531-0324
Mailing Address - Country:US
Mailing Address - Phone:785-770-5225
Mailing Address - Fax:
Practice Address - Street 1:217 SOUTHWIND PL STE 101
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-3159
Practice Address - Country:US
Practice Address - Phone:785-770-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty