Provider Demographics
NPI:1134487762
Name:THOMAS, QUENTIN VIVIAN (MS MCFC)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:VIVIAN
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MS MCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3797 NW 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-1610
Mailing Address - Country:US
Mailing Address - Phone:503-789-3629
Mailing Address - Fax:
Practice Address - Street 1:3797 NW 4TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-1610
Practice Address - Country:US
Practice Address - Phone:503-789-3629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)