Provider Demographics
NPI:1669757316
Name:THOMAS, MELINDA LEIGH (LMFT, CCDP)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:LEIGH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMFT, CCDP
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:L
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT CCDP
Mailing Address - Street 1:217 CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2312
Mailing Address - Country:US
Mailing Address - Phone:724-433-3623
Mailing Address - Fax:
Practice Address - Street 1:5700 ROUTE 982
Practice Address - Street 2:
Practice Address - City:NEW DERRY
Practice Address - State:PA
Practice Address - Zip Code:15671-1027
Practice Address - Country:US
Practice Address - Phone:724-804-8204
Practice Address - Fax:724-203-6551
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
PA101YM0800X
PAMF000627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102903907000Medicaid