MEDICARE: MISS MELISSA LEE THOMAS M.ED MAADC II MARS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1629423470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MELISSA LEE THOMAS M.ED MAADC II MARS

Provider Business Mailing Address
First Line	:	1513 JEFFERSON ROAD
Second Line	:
City	:	BOONVILLE
State	:	MO
Zip	:	65233
Country	:	US
Telephone Number	:	573-836-0076
Fax Number	:	573-449-8344

Provider Business Practice Location Address
First Line	:	2027 CAMPUS DR
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63301-1047
Country	:	US
Telephone Number	:	636-321-7600
Fax Number	:	636-757-3728

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

Provider Enumeration Date	:	04/29/2016
Last Update Date	:	08/30/2024

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