| Professional Association | |
|
3515 S 4th Street Leavenworth KS 66048 | |
| (913) 651-8415 | |
| (913) 772-8580 |
| Full Name | Professional Association |
|---|---|
| Speciality | Psychologist |
| Location | 3515 S 4th Street, Leavenworth, Kansas |
| Authorized Official Name and Position | William Albert Moffitt (VICE PRESIDENT OWNER) |
| Authorized Official Contact | 9136518415 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Professional Association 3515 S 4th Street Leavenworth KS 66048 Ph: (913) 651-8415 | Professional Association 3515 S 4th Street Leavenworth KS 66048 Ph: (913) 651-8415 |
| NPI Number | 1013076215 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 8224017157 |
|---|---|
| Medicare Enrollment ID | O20050330000383 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013076215 | NPI | - | NPPES |
| 08422011 | Other | KS | BCBS KANSAS CITY |
| 004517 | Other | KS | BCBS KANSAS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| Provider Name | Everett D Dehaven |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1083653851 PECOS PAC ID: 2769420900 Enrollment ID: I20050419001058 |
| Provider Name | William A Moffitt |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1417052614 PECOS PAC ID: 9739168196 Enrollment ID: I20050531000155 |
| Provider Name | Jacqueline R Pfeifer |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710082078 PECOS PAC ID: 3476532227 Enrollment ID: I20050620000805 |
| Provider Name | Leif Eric Leaf |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1336244631 PECOS PAC ID: 0840279253 Enrollment ID: I20060410000423 |
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