Provider Demographics
NPI:1114039765
Name:ROSS, THOMAS WILLIAM (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILLIAM
Last Name:ROSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 SE SUNNYSIDE RD
Mailing Address - Street 2:STE 490
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5743
Mailing Address - Country:US
Mailing Address - Phone:503-513-4414
Mailing Address - Fax:503-513-4424
Practice Address - Street 1:10163 SE SUNNYSIDE RD
Practice Address - Street 2:STE 490
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5743
Practice Address - Country:US
Practice Address - Phone:503-513-4414
Practice Address - Fax:503-513-4424
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR001207101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)