=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477736783
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AHA PSYCHOLOGICAL SERVICES, P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2007
-----------------------------------------------------
Last Update Date | 05/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5250 W 94TH TER
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-383-8100
-----------------------------------------------------
Fax | 913-648-8316
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5250 W 94TH TER
-----------------------------------------------------
City | PRAIRIE VILLAGE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66207-2502
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-383-8100
-----------------------------------------------------
Fax | 913-648-8316
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. AVERY H BRATT
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 913-383-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1205
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------