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Individual

THOMAS A. VAN DILLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1301 KS HWY 264, LARNED, KS 67550-0089
(620) 285-4609
Mailing address
1301 KS HWY 264, LARNED, KS 67550-0089
(620) 285-4609

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
T-LP 1377
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
121002
CARRIER ASSIGNED
KS
Enumeration date
08/22/2006
Last updated
07/08/2007
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