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General NPI Number Information
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NPI Number | 1013721679
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Entity Type | Individual
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Provider Name | MELLISSA THOMAS LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1021 W HEMINGWAY BLVD
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City | NAMPA
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State | ID
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Zip | 83651-1763
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Country | US
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Telephone | 208-505-9990
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 261
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City | HEBER CITY
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State | UT
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Zip | 84032-0261
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Country | US
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Telephone | 208-317-0437
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7771141
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License Number State | ID
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