Healthcare Provider Details

I. General information

NPI: 1023403656
Provider Name (Legal Business Name): MERRITT TUTTHILL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 03/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E HIGHWAY 4
MURPHYS CA
95247-9559
US

IV. Provider business mailing address

PO BOX 835
MURPHYS CA
95247-0835
US

V. Phone/Fax

Practice location:
  • Phone: 209-768-6716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number81414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: