MEDICARE: INDIRA THOMASSON LLC

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

General Provider Information

NPI Number	:	1457284606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIRA THOMASSON LLC

Provider Business Mailing Address
First Line	:	2097 LAKE PARK DR SE APT I
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-7657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2097 LAKE PARK DR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8826
Country	:	US
Telephone Number	:	770-284-8283
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	INDIRA THOMASSON
Credential	:	LPC
Telephone Number	:	770-895-3518

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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