Individual provider Active NPI

Thomas William Ross, LCSW

  • Addiction (Substance Use Disorder) Counselor
  • Clackamas, OR
National Provider Identifier
1114039765
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
001207 Issued in OR
Practice address
10163 SE Sunnyside Rd
Ste 490
Clackamas, OR 97015-5743
Phone
(503) 513-4414
Fax
(503) 513-4424
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 001207 OR Primary

Addresses

Primary practice location

10163 SE Sunnyside Rd
Ste 490
Clackamas, OR 97015-5743

Mailing address

10163 SE Sunnyside Rd
Ste 490
Clackamas, OR 97015-5743
Phone (503) 513-4414

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
001207ORMDAddiction (Substance Use Disorder) Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114039765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10163 SE SUNNYSIDE RD",
            "address_2": "STE 490",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155743",
            "telephone_number": "503-513-4414",
            "fax_number": "503-513-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10163 SE SUNNYSIDE RD",
            "address_2": "STE 490",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970155743",
            "telephone_number": "503-513-4414",
            "fax_number": "503-513-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSS",
        "first_name": "THOMAS",
        "middle_name": "WILLIAM",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OR",
            "license": "001207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.