Healthcare Provider Details

I. General information

NPI: 1265426472
Provider Name (Legal Business Name): VICTORIA J HAAG LCMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 W 5TH ST STE 8
HOLTON KS
66436-1788
US

IV. Provider business mailing address

518 MONTANA AVE
HOLTON KS
66436-1142
US

V. Phone/Fax

Practice location:
  • Phone: 785-851-4343
  • Fax: 316-768-4145
Mailing address:
  • Phone: 785-851-4343
  • Fax: 316-768-4145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: