Healthcare Provider Details

I. General information

NPI: 1447362009
Provider Name (Legal Business Name): TAMMI VACHA-HAASE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 E ELIZABETH ST SUITE 2
FORT COLLINS CO
80524-4000
US

IV. Provider business mailing address

1236 E ELIZABETH ST SUITE 2
FORT COLLINS CO
80524-4000
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-1668
  • Fax: 970-472-9381
Mailing address:
  • Phone: 970-488-1668
  • Fax: 970-472-9381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPSY.0002341
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0002341
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: