Provider Demographics
NPI:1003102088
Name:THAMASAK, UNCHANA (MS)
Entity Type:Individual
Prefix:MRS
First Name:UNCHANA
Middle Name:
Last Name:THAMASAK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 S 825 E
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-9524
Mailing Address - Country:US
Mailing Address - Phone:317-371-2373
Mailing Address - Fax:317-471-3508
Practice Address - Street 1:3905 VINCENNES RD
Practice Address - Street 2:SUITE 303
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-3026
Practice Address - Country:US
Practice Address - Phone:317-471-3522
Practice Address - Fax:317-471-3508
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000112A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health