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General NPI Number Information
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NPI Number | 1760299929
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Entity Type | Individual
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Provider Name | ELIZABETH TILL MERRILL ALC
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Gender | Female
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 1121 GREENWOOD XING STE 103
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City | BESSEMER
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State | AL
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Zip | 35022-5687
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Country | US
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Telephone | 205-463-1989
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SOUTHVIEW TER
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City | HOOVER
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State | AL
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Zip | 35244-6748
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Country | US
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Telephone | 205-864-2479
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ALC05133
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License Number State | AL
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