Provider Demographics
NPI:1275898793
Name:PARELLA, THOMAS JOHN (MA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:PARELLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4408
Mailing Address - Country:US
Mailing Address - Phone:989-633-9600
Mailing Address - Fax:989-633-0113
Practice Address - Street 1:2801 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4408
Practice Address - Country:US
Practice Address - Phone:989-633-9600
Practice Address - Fax:989-633-0113
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013083101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional