Provider Demographics
NPI:1750495875
Name:SMURTHWAITE, THOMAS JESS (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JESS
Last Name:SMURTHWAITE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10163 SE SUNNYSIDE RD STE 490
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5720
Mailing Address - Country:US
Mailing Address - Phone:503-513-4400
Mailing Address - Fax:
Practice Address - Street 1:10163 SE SUNNYSIDE RD STE 490
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5720
Practice Address - Country:US
Practice Address - Phone:503-513-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1023103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling