Healthcare Provider Details

I. General information

NPI: 1619038478
Provider Name (Legal Business Name): RICHARD NORMAN THOMAS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 S. 37TH ST. SUITE A
LINCOLN NE
68510-1502
US

IV. Provider business mailing address

127 S. 37TH ST. SUITE A
LINCOLN NE
68510-1502
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-7557
  • Fax: 402-476-9912
Mailing address:
  • Phone: 402-309-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number402
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: