Slade F Thackeray, LPC

NPI #1992460703 in Dallas, Oregon

Provider Information

NPI Number: 1992460703
Entity Type: Individual
Name: Slade F Thackeray, LPC
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Counselor
Credential: LPC
Enumeration Date: Nov 5, 2021
Last Updated: May 28, 2024

Practice Location

Address: 1151 SW LEVENS ST
City: Dallas
State: Oregon
ZIP Code: 97338-2266
Phone: (503) 910-6822

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor	101Y00000X	Primary
Counselor - Mental Health — Mental Health	101YM0800X

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