Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | P1713 | TN |
N | 103T00000X | Psychologist | P1713 | TN |
N | 103TB0200X | Cognitive & Behavioral Psychologist | P1713 | TN |
Y | 103G00000X | Clinical Psychologist | P1713 | TN |
Y | 103TC0700X | Clinical Psychologist | P1713 | TN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | P1713 | TN |
N | 103TF0000X | Family Psychologist | P1713 | TN |
N | 103TP2701X | Group Psychotherapist | P1713 | TN |
NPI | 1114069531 |
---|---|
Provider Name | Dr. Thomas J Burns |
First Address | Kingsport, TN 37660-4828 |
Second Address | Kingsport, TN 37660-4828 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 24/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0190969 | BCBS TN (01) | TN |
123995000 | MAGELLAN (01) | TN |
382880 | BCBS VA (01) | TN |
4516686 | AETNA (01) | TN |
6115592 | UNITED HEALTHCARE (01) | TN |
9165103 | PHCS (01) | TN |
R74811 | (02) | TN |