Provider Demographics
NPI:1366059040
Name:INTERPERSONAL ADVANCED TREATMENT
Entity type:Organization
Organization Name:INTERPERSONAL ADVANCED TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PFANNENSTIEL
Authorized Official - Suffix:
Authorized Official - Credentials:LSCSW
Authorized Official - Phone:785-393-6167
Mailing Address - Street 1:1045 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5003
Mailing Address - Country:US
Mailing Address - Phone:785-393-6167
Mailing Address - Fax:
Practice Address - Street 1:1045 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5003
Practice Address - Country:US
Practice Address - Phone:785-393-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty