Provider Demographics
NPI:1518055078
Name:PRICE, THOMAS L (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:PRICE
Suffix:
Gender:M
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 S LYNCREST AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2515
Mailing Address - Country:US
Mailing Address - Phone:605-274-1119
Mailing Address - Fax:605-271-9983
Practice Address - Street 1:6810 S LYNCREST AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2515
Practice Address - Country:US
Practice Address - Phone:605-274-1119
Practice Address - Fax:605-271-9983
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD154103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6550030Medicaid
SDS69962Medicare PIN