Provider Demographics
NPI:1306148259
Name:RODGERS, THOMAS E JR (MA, NCC, LPC, CADC1)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:RODGERS
Suffix:JR
Gender:M
Credentials:MA, NCC, LPC, CADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MAIN ST
Mailing Address - Street 2:P.O. BOX 1005
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-2655
Mailing Address - Country:US
Mailing Address - Phone:541-523-3646
Mailing Address - Fax:541-523-7602
Practice Address - Street 1:2100 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2655
Practice Address - Country:US
Practice Address - Phone:541-523-3646
Practice Address - Fax:541-523-7602
Is Sole Proprietor?:No
Enumeration Date:2010-11-29
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3278101YM0800X
OR11-06-64101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)