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General NPI Number Information
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NPI Number | 1114957412
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Entity Type | Individual
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Provider Name | THOMAS M MEDLAR LMHC
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1132 WESTFIELD ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-3878
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Country | US
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Telephone | 413-592-1980
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Fax | 413-439-0096
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Provider Business Mailing Address
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Address Line | 5 TAYLOR WAY
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City | MIDDLEBORO
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State | MA
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Zip | 02346-2500
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Country | US
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Telephone | 508-947-3561
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 746
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1513
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License Number State | MA
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