Provider Demographics
NPI:1598138257
Name:FRYE, THOMAS GASTON IV (CADC II)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:GASTON
Last Name:FRYE
Suffix:IV
Gender:M
Credentials:CADC II
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Mailing Address - Street 1:687 CHESHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-5060
Mailing Address - Country:US
Mailing Address - Phone:541-762-4532
Mailing Address - Fax:541-726-2467
Practice Address - Street 1:1651 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-3363
Practice Address - Country:US
Practice Address - Phone:541-762-4532
Practice Address - Fax:541-726-2467
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR16-R-09101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5863OtherCERTIFIED RECIPROCAL ALCOHOL AND DRUG COUNSELOR
OR16-R-09OtherADDICITION COUNSELING BOARD OF OREGON