Provider Demographics
NPI:1386212025
Name:MERRITT, BROOKE (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:622 TREE TOP TRL
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-0478
Mailing Address - Country:US
Mailing Address - Phone:706-814-8425
Mailing Address - Fax:
Practice Address - Street 1:1212 AUGUSTA WEST PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1808
Practice Address - Country:US
Practice Address - Phone:706-826-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-23-68865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst