Healthcare Provider Details

I. General information

NPI: 1386954527
Provider Name (Legal Business Name): ANDREW ROBERT MERRILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N HUDSON AVE
OKLAHOMA CITY OK
73103-3918
US

IV. Provider business mailing address

1029 DENMARK ST
YUKON OK
73099-9619
US

V. Phone/Fax

Practice location:
  • Phone: 405-858-2966
  • Fax:
Mailing address:
  • Phone: 405-812-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: