Provider Demographics
NPI:1326004771
Name:THOMAS, RICK DARWIN (PHD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:DARWIN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 N SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2035
Mailing Address - Country:US
Mailing Address - Phone:816-331-0374
Mailing Address - Fax:813-331-1070
Practice Address - Street 1:409 N SCOTT AVE
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2035
Practice Address - Country:US
Practice Address - Phone:816-331-0374
Practice Address - Fax:813-331-1070
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR0411103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493980700Medicaid
KS0008833Medicare ID - Type Unspecified
KSS78759Medicare UPIN