MEDICARE: KYLIE ANN MERRIMAN LCPC

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	101YP2500X	Professional Counselor	BBH-LCPC-LIC-70705	MT

General Provider Information

NPI Number	:	1699515551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLIE ANN MERRIMAN LCPC

Provider Business Mailing Address
First Line	:	1750 RAY OF HOPE LN
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3502
Country	:	US
Telephone Number	:	406-656-2198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 RAY OF HOPE LN
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59106-3502
Country	:	US
Telephone Number	:	406-656-2198
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	05/29/2024

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