Provider Demographics
NPI:1174506505
Name:STANAGE, THOMAS S (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:STANAGE
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 1:1028 WALNUT
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078
Mailing Address - Country:US
Mailing Address - Phone:605-665-4606
Mailing Address - Fax:605-665-4673
Practice Address - Street 1:1028 WALNUT
Practice Address - Street 2:LEWIS & CLARK BHS
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078
Practice Address - Country:US
Practice Address - Phone:605-665-4606
Practice Address - Fax:605-665-4673
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD342101YM0800X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
3450Medicare ID - Type Unspecified