Provider Demographics
NPI:1184634966
Name:KRIESHOK, THOMAS STEPHEN (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHEN
Last Name:KRIESHOK
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 1:7930 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2629
Mailing Address - Country:US
Mailing Address - Phone:913-599-5075
Mailing Address - Fax:
Practice Address - Street 1:1122 W CAMPUS RD
Practice Address - Street 2:ROOM 621
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-3101
Practice Address - Country:US
Practice Address - Phone:785-864-9654
Practice Address - Fax:785-864-3820
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS599103T00000X, 103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy