Provider Demographics
NPI:1235292137
Name:THOMAS, JIMMIE BRYANT (MA, LPC, QMHP)
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:BRYANT
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MA, LPC, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1684
Mailing Address - Country:US
Mailing Address - Phone:503-481-9284
Mailing Address - Fax:
Practice Address - Street 1:2421 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1220
Practice Address - Country:US
Practice Address - Phone:503-588-5352
Practice Address - Fax:503-585-4990
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC2474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health