Healthcare Provider Details

I. General information

NPI: 1306148259
Provider Name (Legal Business Name): THOMAS E RODGERS JR. MA, NCC, LPC, CADC1
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 SE REED MARKET RD STE 280
BEND OR
97702-3817
US

IV. Provider business mailing address

300 SE REED MARKET RD STE 280
BEND OR
97702-3817
US

V. Phone/Fax

Practice location:
  • Phone: 541-871-7024
  • Fax: 888-810-2993
Mailing address:
  • Phone: 541-871-7024
  • Fax: 888-810-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11-06-64
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC3278
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: