Provider Demographics
NPI:1437703543
Name:TOMAS, JORDEN A (BA)
Entity Type:Individual
Prefix:
First Name:JORDEN
Middle Name:A
Last Name:TOMAS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 68TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97478-7319
Mailing Address - Country:US
Mailing Address - Phone:360-448-0999
Mailing Address - Fax:
Practice Address - Street 1:1790 W 11TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-3871
Practice Address - Country:US
Practice Address - Phone:541-686-2688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2022-01-12
Deactivation Date:2021-12-10
Deactivation Code:
Reactivation Date:2022-01-12
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health