MEDICARE: MRS. MERRILL L LITTLEBERRY LCSW, LCDC, CCM

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9615	TX
2	1041C0700X	Clinical Social Worker	28682	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	63003	OTHER	TX	HORIZON HEALTH
2	51MX	OTHER	TX	BC/BS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	560613	OTHER	TX	VALUE OPTIONS

General Provider Information

NPI Number	:	1649235060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MERRILL L LITTLEBERRY LCSW, LCDC, CCM

Provider Business Mailing Address
First Line	:	4200 SOUTH FWY STE 424
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1405
Country	:	US
Telephone Number	:	817-920-9321
Fax Number	:	817-920-9336

Provider Business Practice Location Address
First Line	:	4200 SOUTH FWY
Second Line	:	SUITE 424
City	:	FORT WORTH
State	:	TX
Zip	:	76115-1400
Country	:	US
Telephone Number	:	817-920-9321
Fax Number	:	817-920-9336

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	02/24/2026

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