Basic Information
| Provider Information | |||||||||
| NPI: | 1598138257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRYE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | GASTON | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | CADC II | ||||||||
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| Mailing Information | |||||||||
| Address1: | 687 CHESHIRE AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974025060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417624532 | ||||||||
| FaxNumber: | 5417262467 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651 CENTENNIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974773363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417624532 | ||||||||
| FaxNumber: | 5417262467 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 16-R-09 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 5863 | 01 | MO | CERTIFIED RECIPROCAL ALCOHOL AND DRUG COUNSELOR | OTHER | 16-R-09 | 01 | OR | ADDICITION COUNSELING BOARD OF OREGON | OTHER |