De Vries, Thomas

De Vries, Thomas is an sole proprietor health care provider with primary practice located at 405 W Coutry Club Rd , Roswell NM 88201-5209. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Prescribing (Medical), Behavioral Health & Social Service Providers / Health. Behavioral Health & Social Service Providers / Health is his primary health care specialty. De Vries, Thomas can be contacted via phone (505) 273-0574.

Contact Information

Primary practice address
405 W Coutry Club Rd Roswell NM 88201-5209
Phone: (505) 273-0574
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Prescribing (Medical) 103TP0016X 0047C New Mexico
Behavioral Health & Social Service Providers / Health 103TH0004X 1233 New Mexico

Profile Details

NPI number 1700200722
LBN Legal business name De Vries, Thomas
Credentials PH.D
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 11th, 2014
Last updated Oct 21st, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700200722 NPPES
New Mexico Other 1233 NM STATE BOARD OF PSYCHOLOGIST EXAMINERS LICENSE

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