Basic Information
| Provider Information | |||||||||
| NPI: | 1003331943 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DOOLEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | WILSON | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS,LPC, CRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2607 WALKER RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973052663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035519723 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1515 LIBERTY ST SE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973024345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039516280 | ||||||||
| FaxNumber: | 5034683130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2017 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | R4295 | OR | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | C6595 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.