Provider Demographics
NPI:1407933971
Name:LAURENCE, LANCE THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:THOMAS
Last Name:LAURENCE
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 1:12524 WILLOW COVE WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-5348
Mailing Address - Country:US
Mailing Address - Phone:865-966-9834
Mailing Address - Fax:
Practice Address - Street 1:305 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-4824
Practice Address - Country:US
Practice Address - Phone:865-584-8547
Practice Address - Fax:865-584-5932
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP000771103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN226475000OtherMAGELLAN PROVIDER NUMBER
TN368700OtherTRIAGON/MEDIGAP PROV #
TN0023031OtherBC/BS PROVIDER NUMBER
TN226475000OtherMAGELLAN PROVIDER NUMBER