MEDICARE: RANDI WEBER THOMA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	61123327	WA
2	101YM0800X	Mental Health Counselor	C1115	OR

General Provider Information

NPI Number	:	1013001692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDI WEBER THOMA LPC

Provider Business Mailing Address
First Line	:	4800 S MACADAM AVE STE 350
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3970
Country	:	US
Telephone Number	:	503-684-7948
Fax Number	:	503-684-7958

Provider Business Practice Location Address
First Line	:	4800 S MACADAM AVE STE 350
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97239-3970
Country	:	US
Telephone Number	:	503-684-7948
Fax Number	:	503-684-7958

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	11/03/2023

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Directions to “ RANDI WEBER THOMA LPC” Practice Location

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