Thomas Lee Anderson, PHD
Individual provider Active NPI Clinical Psychologist · Ft. Jackson, SC
NPI 1104892330 · NPPES record last updated Jun 10, 2013
Key facts
- NPI
- 1104892330
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 386 (SC)
- Practice address
- 10000 Hampton Parkway
Office of the Command Psychologist
Ft. Jackson, SC 20207 - Phone
- (803) 751-8794
- NPI assigned
- Feb 27, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Philosophy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 386 | SC | Yes |
Addresses
Primary practice location
10000 Hampton Parkway
Office of the Command Psychologist
Ft. Jackson, SC 20207
Mailing address
10000 Hampton Parkway
Office of the Command Psychologist
Ft. Jackson, SC 20207
Phone (803) 751-8794
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS0298 | Medicaid | SC |
Other providers in Ft. Jackson, SC
- Harris Ahmad Abbasi
- Ahc Moncrief-Jackson
- Larry Kenneth Andreo
- Gary Tillery Applewhite
- Colleen Barkley
- Mitchell Eli Becker
- David Alexander Beltran
All providers in Ft. Jackson, SC · Clinical Psychologist in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.