Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 39000112A | IN |
NPI | 1003102088 |
---|---|
Provider Name | Mrs. Unchana Thamasak |
First Address | Zionsville, IN 46077-9524 |
Second Address | Indianapolis, IN 46268-3026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 28/06/2011 |