Provider Demographics
NPI:1043549207
Name:THOMA, DANIEL STEPHEN (MA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:STEPHEN
Last Name:THOMA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SW 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3229
Mailing Address - Country:US
Mailing Address - Phone:503-382-5386
Mailing Address - Fax:503-670-8349
Practice Address - Street 1:601 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3229
Practice Address - Country:US
Practice Address - Phone:503-382-5386
Practice Address - Fax:503-670-8349
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1140101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health