Healthcare Provider Details

I. General information

NPI: 1457942831
Provider Name (Legal Business Name): THOMAS JASON HENSLEY CADCR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 NW MADRAS HWY
PRINEVILLE OR
97754-1416
US

IV. Provider business mailing address

PO BOX 1710
REDMOND OR
97756-0516
US

V. Phone/Fax

Practice location:
  • Phone: 541-323-5330
  • Fax:
Mailing address:
  • Phone: 541-504-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHA-R-6433
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number23-11-10944
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: