Provider Demographics
NPI:1407053812
Name:MERRILL, BRANDI MICHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MICHELLE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S MAIN ST
Mailing Address - Street 2:STE P3
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3261
Mailing Address - Country:US
Mailing Address - Phone:208-406-9107
Mailing Address - Fax:
Practice Address - Street 1:200 S MAIN ST
Practice Address - Street 2:STE P3
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3261
Practice Address - Country:US
Practice Address - Phone:208-406-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-375081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical