Provider Demographics
NPI:1487012340
Name:MERLAU, KATHY-JO (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:KATHY-JO
Middle Name:
Last Name:MERLAU
Suffix:
Gender:F
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 MAIN ST STE 207
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2945
Mailing Address - Country:US
Mailing Address - Phone:802-738-8002
Mailing Address - Fax:802-419-9699
Practice Address - Street 1:390 RIVER ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156-2226
Practice Address - Country:US
Practice Address - Phone:802-886-4567
Practice Address - Fax:802-886-4520
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000684101YA0400X
VT1510125895101YA0400X
VT0680125284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)