Healthcare Provider Details

I. General information

NPI: 1578940144
Provider Name (Legal Business Name): ELIZABETH MERRILL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N THORNTON ST SUITE J
CLOVIS NM
88101-5508
US

IV. Provider business mailing address

1200 N THORNTON ST SUITE J
CLOVIS NM
88101-5508
US

V. Phone/Fax

Practice location:
  • Phone: 575-935-8522
  • Fax:
Mailing address:
  • Phone: 575-935-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0170731
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: