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General NPI Number Information
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NPI Number | 1629146386
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Entity Type | Individual
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Provider Name | MICHAEL H. MERRILL PHD, LCPC
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Gender | Male
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1 E DELAWARE PL SUITE 304
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City | CHICAGO
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State | IL
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Zip | 60611-4962
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Country | US
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Telephone | 312-944-6425
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Fax | 312-944-6452
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Provider Business Mailing Address
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Address Line | 1 E DELAWARE PL SUITE 304
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City | CHICAGO
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State | IL
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Zip | 60611-4962
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Country | US
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Telephone | 312-944-6425
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Fax | 312-944-6452
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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Taxonomy #3
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | IL
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