Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | R4295 | OR |
Y | 101YP2500X | Professional Counselor | C6595 | OR |
NPI | 1003331943 |
---|---|
Provider Name | Mr. Thomas Wilson Dooley |
First Address | Salem, OR 97305-2663 |
Second Address | Salem, OR 97302-4345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2017 |
Last Update Date | 10/02/2022 |