MEDICARE: STACEY LEE MERRELL LMFT

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	106H00000X	Marriage & Family Therapist	MFC 46624	CA

General Provider Information

NPI Number	:	1427245323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY LEE MERRELL LMFT

Provider Business Mailing Address
First Line	:	7365 CARNELIAN ST STE 240
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-1136
Country	:	US
Telephone Number	:	909-281-1557
Fax Number	:	877-850-5695

Provider Business Practice Location Address
First Line	:	7365 CARNELIAN ST STE 240
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-1136
Country	:	US
Telephone Number	:	909-281-1557
Fax Number	:	877-850-5695

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

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	05/14/2025

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