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General NPI Number Information
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NPI Number | 1871059030
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Entity Type | Organization
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Legal Business Name | EDWARD MERKLE
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 4770 S RIDGEWOOD AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-4544
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Country | US
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Telephone | 386-416-9767
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Fax |
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Provider Business Mailing Address
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Address Line | 313 CEDAR AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2618
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Country | US
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Telephone | 386-416-9767
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD MERKLE
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Credential | LMHC
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Telephone | 386-416-9767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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