Active NPI
Thomas De Vries, PH.D
- Health Psychologist
- Roswell, NM
National Provider Identifier
1700200722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Psychologist
- License
- 1233
- Practice address
- 405 W Coutry Club Rd
Roswell, NM 88201-5209 - Phone
- (505) 273-0574
- NPI assigned
- Feb 11, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prescribing (Medical) Psychologist | 103TP0016X | 0047C | NM | |
| Health Psychologist | 103TH0004X | 1233 | NM | Primary |
Addresses
Primary practice location
405 W Coutry Club Rd
Roswell, NM 88201-5209
Mailing address
706 N Pennsylvania Ave
Roswell, NM 88201
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1233 | Other | NM | NM STATE BOARD OF PSYCHOLOGIST EXAMINERS LICENSE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0047C | NM | MD | Prescribing (Medical) Psychologist |
| 1233 | NM | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392076800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666310400000",
"number": "1700200722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "706 N PENNSYLVANIA AVE",
"city": "ROSWELL",
"state": "NM",
"postal_code": "88201"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "405 W COUTRY CLUB RD",
"city": "ROSWELL",
"state": "NM",
"postal_code": "882015209",
"telephone_number": "505-273-0574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE VRIES",
"first_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-02-11",
"last_updated": "2022-10-21",
"certification_date": "2022-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "103TP0016X",
"taxonomy_group": "",
"desc": "Psychologist, Prescribing (Medical)",
"state": "NM",
"license": "0047C",
"primary": false
},
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "NM",
"license": "1233",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NM STATE BOARD OF PSYCHOLOGIST EXAMINERS LICENSE",
"identifier": "1233",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Roswell, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.