Provider Demographics
NPI:1952470668
Name:THOMAS J. LANTSBERGER, PH.D. LLC
Entity Type:Organization
Organization Name:THOMAS J. LANTSBERGER, PH.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANTSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:314-881-4260
Mailing Address - Street 1:14561 NORTH OUTER 40 ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-881-4260
Mailing Address - Fax:314-881-4262
Practice Address - Street 1:14561 NORTH OUTER 40 ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-881-4260
Practice Address - Fax:314-881-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOM001687103T00000X
MO01687103TC0700X
MOMO0004978104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000015277Medicare PIN