Provider Demographics
NPI:1053469320
Name:MERKEL, CARMELLA L (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CARMELLA
Middle Name:L
Last Name:MERKEL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 192
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:IL
Mailing Address - Zip Code:60184-0192
Mailing Address - Country:US
Mailing Address - Phone:630-742-8271
Mailing Address - Fax:773-868-1580
Practice Address - Street 1:3139 N LINCOLN AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3114
Practice Address - Country:US
Practice Address - Phone:630-742-8271
Practice Address - Fax:773-868-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005882101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional