MEDICARE: MS. DONNA MERRITT

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	70000074A	IN
2	2084P0800X	Psychiatry Physician	70000074	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000607200	OTHER	IN	ANTHEM PIN NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942461520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA MERRITT

Provider Business Mailing Address
First Line	:	1310 KINGS COVE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1671
Country	:	US
Telephone Number	:	317-581-1558
Fax Number	:

Provider Business Practice Location Address
First Line	:	1310 KINGS COVE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1671
Country	:	US
Telephone Number	:	317-581-1558
Fax Number	:

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	07/20/2010

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Directions to “ MS. DONNA MERRITT ” Practice Location

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