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General NPI Number Information
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NPI Number | 1346881778
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Entity Type | Individual
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Provider Name | EVAN MICHAEL THAYER LCSW
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Gender | Male
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 12655 SW CENTER ST STE 100
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City | BEAVERTON
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State | OR
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Zip | 97005-1600
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Country | US
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Telephone | 503-828-3402
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Fax |
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Provider Business Mailing Address
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Address Line | 16055 SW WALKER RD # 443
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City | BEAVERTON
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State | OR
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Zip | 97006-4942
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Country | US
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Telephone | 971-224-6357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L30018
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License Number State | OR
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