Individual
SHAD M THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, MSW, CADC III
Contact information
Practice address
2200 4TH ST, BAKER CITY, OR 97814-2615
(541) 573-7303
(541) 573-5938
Mailing address
PO BOX 138, BURNS, OR 97720-0138
(541) 573-7303
(541) 573-5938
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
16-01-16
OR
1041C0700X
Clinical Social Worker
Primary
L6915
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090450
—
OR
01
—
500666423
MCD
OR
Enumeration date
12/30/2011
Last updated
04/03/2017
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