MEDICARE: MERRELL FAMILY COUNSELING, INC.

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

General Provider Information

NPI Number	:	1861938722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRELL FAMILY COUNSELING, INC.

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	:	PRESIDENT
Name	:	STACEY MERRELL
Credential	:	LMFT
Telephone Number	:	951-218-0951

Provider Enumeration Date	:	01/16/2017
Last Update Date	:	05/14/2025

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