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General NPI Number Information
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NPI Number | 1790360444
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Entity Type | Individual
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Provider Name | COURTNEY MERRILL LMFT
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Gender | Female
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Dates
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Enumeration Date | 03/15/2021
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 208 N 350 E
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City | VINEYARD
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State | UT
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Zip | 84059-7601
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Country | US
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Telephone | 202-494-0667
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Fax |
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Provider Business Mailing Address
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Address Line | 208 N 350 E
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City | VINEYARD
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State | UT
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Zip | 84059-7601
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Country | US
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Telephone | 202-494-0667
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 100.0111473
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 5869472-3902
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License Number State | UT
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