MEDICARE: DR. THOMAS S MERRILL PH.D., ABPP

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	103TC0700X	Clinical Psychologist	PSY243	HI

General Provider Information

NPI Number	:	1871660217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS S MERRILL PH.D., ABPP

Provider Business Mailing Address
First Line	:	12682 W BAJADA RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-2808
Country	:	US
Telephone Number	:	623-388-4354
Fax Number	:	623-388-4354

Provider Business Practice Location Address
First Line	:	12682 W BAJADA RD
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-2808
Country	:	US
Telephone Number	:	623-388-4354
Fax Number	:	623-388-4354

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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