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General NPI Number Information
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NPI Number | 1508223272
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Entity Type | Individual
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Provider Name | MERLYN ANTONY M.R.C., CRC, LPC
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Gender | Female
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Dates
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Enumeration Date | 01/26/2016
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Last Update Date | 01/26/2016
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Provider Practice Location Address
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Address Line | 2436 S INTERSTATE 35 E STE 336
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City | DENTON
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State | TX
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Zip | 76205-4900
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Country | US
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Telephone | 970-320-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 2436 S INTERSTATE 35 E STE 336
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City | DENTON
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State | TX
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Zip | 76205-4900
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Country | US
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Telephone |
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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 | 71916
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number | 00116546
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License Number State | TX
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