1154564185 NPI number — DR. THOMAS WESLEY AYALA LICENSED COUNSELOR

Table of content: DR. THOMAS WESLEY AYALA LICENSED COUNSELOR (NPI 1154564185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154564185 NPI number — DR. THOMAS WESLEY AYALA LICENSED COUNSELOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYALA
Provider First Name:
THOMAS
Provider Middle Name:
WESLEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
LICENSED COUNSELOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154564185
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEBANON
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97355-0280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-258-8210
Provider Business Mailing Address Fax Number:
541-258-8212

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
880 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-258-8210
Provider Business Practice Location Address Fax Number:
541-258-8212
Provider Enumeration Date:
04/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  C1962 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 227513 . This is a "NATIONAL BOARD CERTIFIED COUNSELOR" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C1962 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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