1932296142 NPI number — RICK D. THOMAS, PH.D. LLC

Table of content: (NPI 1932296142)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932296142 NPI number — RICK D. THOMAS, PH.D. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICK D. THOMAS, PH.D. LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932296142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 N SCOTT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64012-2035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-331-0374
Provider Business Mailing Address Fax Number:
816-331-1070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 N SCOTT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64012-2035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-331-0374
Provider Business Practice Location Address Fax Number:
816-331-1070
Provider Enumeration Date:
10/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
RICK
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
816-331-0374

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  R0411 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R0411 . This is a "MO STATE LICENSE #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 25723021 . This is a "INDIVIDUAL PROVIDER NUMBE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 149052 . This is a "VALUE OPTIONS PROVIDER #" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2018341 . This is a "CIGNA PROVIDER NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 37107016 . This is a "BCBS GROUP PROVIDER NUMBE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 6166639 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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