Roderick Edward Theis II, MSW, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

L4084 Issued in OR

Practice address

622 Airport Rd
Pendleton, OR 97801-4598

Phone

(541) 276-0057

Fax

(541) 276-1704

NPI assigned

Sep 28, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pendleton Acadmies

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Pendleton, OR
  • NPI 1417991258

  Mental Health

  NPD (past)

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190937600000",
    "number": "1780871236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 AIRPORT RD",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978014598",
            "telephone_number": "541-276-0057",
            "fax_number": "541-276-1704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 AIRPORT RD",
            "city": "PENDLETON",
            "state": "OR",
            "postal_code": "978014598",
            "telephone_number": "541-276-0057",
            "fax_number": "541-276-1704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEIS",
        "first_name": "RODERICK",
        "middle_name": "EDWARD",
        "name_suffix": "II",
        "credential": "MSW, LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-28",
        "last_updated": "2007-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OR",
            "license": "L4084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF OREGON LICENSE",
            "identifier": "L4084",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Terrel L. Templeman, PH.D.
• Laurie Patricia Terjeson
• Terry Wigley MD PC
• Kamala Kim Tewee, CRM, CADCR
• Holly R Thau, LCSW
• Fred H Thomas III, LPN
• Gary Thomas, MS
• John Earl Thomas, QMHA
• Kelsey R Thomas
• Kimberly Kerry Thomas, CPHT

• Mental Health Counselor in Pendleton, OR
• Providers in Pendleton, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.