MEDICARE: MATTHEW O MERRICK LPC, NCC

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	101YM0800X	Mental Health Counselor	LPC-15691	AZ

General Provider Information

NPI Number	:	1295280493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW O MERRICK LPC, NCC

Provider Business Mailing Address
First Line	:	4160 E SCHROEDER RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-9507
Country	:	US
Telephone Number	:	520-248-1744
Fax Number	:	520-448-0719

Provider Business Practice Location Address
First Line	:	4160 E SCHROEDER RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85739-9507
Country	:	US
Telephone Number	:	520-248-1744
Fax Number	:	520-448-0719

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

Provider Enumeration Date	:	08/18/2016
Last Update Date	:	08/18/2016

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