Provider Demographics
NPI:1659437747
Name:BREWER, THOMAS JAMES (PSYD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JAMES
Last Name:BREWER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW WILSHIRE ST STE 230
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5043
Mailing Address - Country:US
Mailing Address - Phone:503-292-1885
Mailing Address - Fax:503-292-1787
Practice Address - Street 1:9900 SW WILSHIRE ST STE 230
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5043
Practice Address - Country:US
Practice Address - Phone:503-292-1885
Practice Address - Fax:503-292-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1622103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPACIFICSOURCEOtherPROVIDER #
OR023158Medicaid