Provider Demographics
NPI:1871790287
Name:JOHNS, THOMAS DAVANT (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVANT
Last Name:JOHNS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:MO
Mailing Address - Zip Code:63052-1440
Mailing Address - Country:US
Mailing Address - Phone:636-282-7269
Mailing Address - Fax:
Practice Address - Street 1:2933 SPRING MEADOW DR
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:MO
Practice Address - Zip Code:63052-1440
Practice Address - Country:US
Practice Address - Phone:636-282-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYR0255103TB0200X, 103TP2701X
MOPYRO255103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy