Healthcare Provider Details

I. General information

NPI: 1730697574
Provider Name (Legal Business Name): EMILY MERRYWEATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 SAXONY RD STE 203
ENCINITAS CA
92024-6780
US

IV. Provider business mailing address

7759 CALLE MEJOR
CARLSBAD CA
92009-8946
US

V. Phone/Fax

Practice location:
  • Phone: 760-783-5583
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4676
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: