Healthcare Provider Details

I. General information

NPI: 1952917197
Provider Name (Legal Business Name): THOMAS GULICK CSWA, CADCIII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61667 SOMERSET DR
BEND OR
97702-8704
US

IV. Provider business mailing address

1421 NE 8TH ST
BEND OR
97701-4466
US

V. Phone/Fax

Practice location:
  • Phone: 541-241-3430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberA16853
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: