Provider Demographics
NPI:1003316043
Name:THOM, JENNY (LPC)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:THOM
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:THOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9670 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-3307
Mailing Address - Country:US
Mailing Address - Phone:971-229-4009
Mailing Address - Fax:866-324-6009
Practice Address - Street 1:9670 SW BEAVERTON HILLSDALE HWY
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-3307
Practice Address - Country:US
Practice Address - Phone:971-229-4009
Practice Address - Fax:866-324-6009
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC6096101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health