Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | OR |
NPI | 1003097718 |
---|---|
Provider Name | Mr. Thomas Michael Clute |
First Address | Oregon City, OR 97045-4035 |
Second Address | Oregon City, OR 97045-4066 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2007 |
Last Update Date | 02/08/2012 |