Provider Demographics
NPI:1497527782
Name:THOMAS, MELAYA
Entity Type:Individual
Prefix:
First Name:MELAYA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15030 S RAVINIA AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3256
Mailing Address - Country:US
Mailing Address - Phone:630-201-0465
Mailing Address - Fax:
Practice Address - Street 1:15030 S RAVINIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3256
Practice Address - Country:US
Practice Address - Phone:630-201-0465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health