Provider Demographics
NPI:1699588608
Name:THOMAS, RYAN NOAH MICHAEL (BS CRIM JUST)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NOAH MICHAEL
Last Name:THOMAS
Suffix:
Gender:M
Credentials:BS CRIM JUST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230286
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97281-0286
Mailing Address - Country:US
Mailing Address - Phone:971-488-4190
Mailing Address - Fax:
Practice Address - Street 1:12971 SW PACIFIC HWY FL 2
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5032
Practice Address - Country:US
Practice Address - Phone:971-488-4190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health