Provider Demographics
NPI:1114069531
Name:BURNS, THOMAS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:BURNS
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 1:108 E MAIN ST
Mailing Address - Street 2:STE 210A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4257
Mailing Address - Country:US
Mailing Address - Phone:423-392-6898
Mailing Address - Fax:423-392-6900
Practice Address - Street 1:108 E MAIN ST
Practice Address - Street 2:STE 210A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4257
Practice Address - Country:US
Practice Address - Phone:423-392-6898
Practice Address - Fax:423-392-6900
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1713103T00000X, 103TB0200X, 103TC2200X, 103TF0000X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN382880OtherBCBS VA
TN0190969OtherBCBS TN
TN6115592OtherUNITED HEALTHCARE
TN123995000OtherMAGELLAN
TN9165103OtherPHCS
TN4516686OtherAETNA
TN6115592OtherUNITED HEALTHCARE
TNR74811Medicare UPIN