MEDICARE: MELISSA THORNTON THOMAS LICSW, PIP

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	1041C0700X	Clinical Social Worker	4156C	AL

General Provider Information

NPI Number	:	1053954651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA THORNTON THOMAS LICSW, PIP

Provider Business Mailing Address
First Line	:	2204 LAKESHORE DR
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6729
Country	:	US
Telephone Number	:	205-516-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2204 LAKESHORE DR
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6729
Country	:	US
Telephone Number	:	205-874-7844
Fax Number	:

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

Provider Enumeration Date	:	10/26/2019
Last Update Date	:	10/26/2019

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