Provider Demographics
NPI:1255544425
Name:FAURIA, THOMAS M (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:FAURIA
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 1:2650 SUZANNE WAY 120
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7619
Mailing Address - Country:US
Mailing Address - Phone:541-345-2800
Mailing Address - Fax:541-345-4419
Practice Address - Street 1:2650 SUZANNE WAY 120
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7619
Practice Address - Country:US
Practice Address - Phone:541-345-2800
Practice Address - Fax:541-345-4419
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR722103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR810573161OtherCLINIC TAX ID
OR844704003OtherREGENCE BCBSO PROV NO
OR844704003OtherREGENCE BCBSO PROV NO