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General NPI Number Information
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NPI Number | 1003470139
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Entity Type | Individual
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Provider Name | KIM ANN MERRILL MA, LPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 04/24/2019
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Provider Practice Location Address
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Address Line | 6658 GUNPARK DR STE 201
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City | BOULDER
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State | CO
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Zip | 80301-3375
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Country | US
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Telephone | 303-931-6052
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Fax |
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Provider Business Mailing Address
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Address Line | 13915 SHANNON DR
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City | BROOMFIELD
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State | CO
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Zip | 80023-4245
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Country | US
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Telephone | 720-432-9955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0000914
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License Number State | CO
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