Individual
SLADE F THACKERAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
1151 SW LEVENS ST, DALLAS, OR 97338-2266
(503) 910-6822
(971) 357-2444
Mailing address
1151 SW LEVENS ST, DALLAS, OR 97338-2266
(503) 910-6822
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
C8279
OR
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
11/05/2021
Last updated
05/28/2024
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