Individual
JASON THEDSOMBANDITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3600 13TH ST, BAKER CITY, OR 97814-1346
(541) 388-6195
(541) 523-8067
Mailing address
3425 13TH ST, BAKER CITY, OR 97814-1340
(541) 523-7400
(541) 523-4927
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
T-23-3406
OR
Other
Enumeration date
01/21/2025
Last updated
01/31/2025
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