Healthcare Provider Details

I. General information

NPI: 1134556087
Provider Name (Legal Business Name): INTERPERSONAL PSYCHIATRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 02/17/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 E 23RD ST
LAWRENCE KS
66046-5003
US

IV. Provider business mailing address

1045 E 23RD ST
LAWRENCE KS
66046-5003
US

V. Phone/Fax

Practice location:
  • Phone: 785-393-6167
  • Fax: 888-965-5680
Mailing address:
  • Phone: 785-393-6167
  • Fax: 888-965-5680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number0435947
License Number StateKS

VIII. Authorized Official

Name: DR. HITEN SONI
Title or Position: CEO
Credential: MD
Phone: 785-393-6167