Provider Demographics
NPI:1326279654
Name:THOMAS A. BLANSETT, PH.D., INC.
Entity Type:Organization
Organization Name:THOMAS A. BLANSETT, PH.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:BLANSETT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:417-886-4011
Mailing Address - Street 1:2200 E SUNSHINE ST STE 318
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-1861
Mailing Address - Country:US
Mailing Address - Phone:417-886-4011
Mailing Address - Fax:417-886-4011
Practice Address - Street 1:2200 E SUNSHINE ST STE 318
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1861
Practice Address - Country:US
Practice Address - Phone:417-886-4011
Practice Address - Fax:417-886-4011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYRO336103TA0700X, 103TC0700X, 103TC2200X, 103TF0200X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty