Healthcare Provider Details

I. General information

NPI: 1477987071
Provider Name (Legal Business Name): AUTUMN K MERRISS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AUTUMN K TURNER

II. Dates (important events)

Enumeration Date: 08/30/2013
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

IV. Provider business mailing address

160 BRIDLEWOOD CT
ALVATON KY
42122-8760
US

V. Phone/Fax

Practice location:
  • Phone: 270-791-8189
  • Fax: 270-201-5890
Mailing address:
  • Phone: 270-799-1566
  • Fax: 270-201-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3798
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: