Active NPI
Thomas A. Van Dillen
- Clinical Psychologist
- Larned, KS
National Provider Identifier
1699881458
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- T-LP 1377
- Practice address
- 1301 KS Hwy 264
Larned, KS 67550-0089 - Phone
- (620) 285-4609
- NPI assigned
- Aug 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | T-LP 1377 | KS | Primary |
Addresses
Primary practice location
1301 KS Hwy 264
Larned, KS 67550-0089
Mailing address
1301 KS Hwy 264
Larned, KS 67550-0089
Phone (620) 285-4609
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121002 | Other | KS | CARRIER ASSIGNED |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-LP 1377 | KS | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699881458",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 KS HWY 264",
"city": "LARNED",
"state": "KS",
"postal_code": "675500089",
"telephone_number": "620-285-4609"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 KS HWY 264",
"city": "LARNED",
"state": "KS",
"postal_code": "675500089",
"telephone_number": "620-285-4609"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN DILLEN",
"first_name": "THOMAS",
"middle_name": "A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KS",
"license": "T-LP 1377",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARRIER ASSIGNED",
"identifier": "121002",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Larned, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.