Healthcare Provider Details

I. General information

NPI: 1477562387
Provider Name (Legal Business Name): CHRISTOPHER RAY MERRELL M.A., LPC, CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 SANTE FE TRAIL SUITE 3
DUNCANVILLE TX
75137-3063
US

IV. Provider business mailing address

1106 SANTE FE TRAIL SUITE 3
DUNCANVILLE TX
75137-3063
US

V. Phone/Fax

Practice location:
  • Phone: 469-337-1160
  • Fax: 972-218-7754
Mailing address:
  • Phone: 469-337-1160
  • Fax: 972-218-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number60363
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number40746
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: