Provider Demographics
NPI:1548548142
Name:THOMAS, MELINDA J (LPC NCC)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:J
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 ZOA DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-1715
Mailing Address - Country:US
Mailing Address - Phone:512-657-8778
Mailing Address - Fax:
Practice Address - Street 1:2109 ZOA DR
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-1715
Practice Address - Country:US
Practice Address - Phone:512-657-8778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-30
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64908101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist