MEDICARE: DR. NANCY K MERBITZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071006307	IL
2	103TC0700X	Clinical Psychologist	6301008968	MI
3	103TC0700X	Clinical Psychologist	20043655A	IN

General Provider Information

NPI Number	:	1255340030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY K MERBITZ PH.D.

Provider Business Mailing Address
First Line	:	970 BEECHTREE DR
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-1072
Country	:	US
Telephone Number	:	708-567-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	6296 RUCKER RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4852
Country	:	US
Telephone Number	:	708-567-6778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	10/30/2025

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