Provider Demographics
NPI:1184760746
Name:MILLS, THOMAS RODNEY JR (RC 1)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RODNEY
Last Name:MILLS
Suffix:JR
Gender:M
Credentials:RC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 SE 12TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-4898
Mailing Address - Country:US
Mailing Address - Phone:503-227-3128
Mailing Address - Fax:
Practice Address - Street 1:5008 NE KILLINGSWORTH
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-0011
Practice Address - Country:US
Practice Address - Phone:503-402-8116
Practice Address - Fax:503-284-2093
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered372600000XNursing Service Related ProvidersAdult Companion