Slade F Thackeray, LPC

Primary specialty

CounselorTaxonomy code 101Y00000X

License

C8279 Issued in OR

Practice address

1151 SW Levens St
Dallas, OR 97338-2266

Phone

(503) 910-6822

Fax

(971) 357-2444

NPI assigned

Nov 5, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Mindful Therapy Group PC

  • Clinical Social Worker
  • Mountlake Terrace, WA
  • NPI 1316238678

  Mental Health, OR

  Medicare reassignment NPD
• Sparrow Professional Development & Counseling Center

  • Counselor
  • Dallas, OR
  • NPI 1881358901
  NPD

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

{
    "created_epoch": "1636070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716854400000",
    "number": "1992460703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 SW LEVENS ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382266",
            "telephone_number": "503-910-6822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 SW LEVENS ST",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973382266",
            "telephone_number": "503-910-6822",
            "fax_number": "971-357-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKERAY",
        "first_name": "SLADE",
        "middle_name": "F",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-05",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OR",
            "license": "C8279",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "https://www.sparrowcounselingpnw.com/",
            "affiliation": "N",
            "endpointDescription": "website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "practice information",
            "address_1": "607 SE Jefferson St",
            "city": "Dallas",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973382025",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Pilar Taylor
• Scott Michael Taylor
• Timothy N Taylor, PMHNP
• Kirsten Emily Teixeira, PMHNP
• Margaret Ann Terry, M.A.
• Cindy Thomas, LPC
• Richard Mathew Thompson
• Thrifty Payless Inc
• Thrive Therapy & Wellness
• William A. Tice

• Counselor in Dallas, OR
• Providers in Dallas, OR by specialty
• Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.