Provider Demographics
NPI:1497479497
Name:MERRITT, MAX JOSEPH
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:JOSEPH
Last Name:MERRITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MAX
Other - Middle Name:JOSEPH
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10251 RIDGELINE DR APT B290
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-2360
Mailing Address - Country:US
Mailing Address - Phone:509-205-4741
Mailing Address - Fax:
Practice Address - Street 1:208 CULLUM AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4534
Practice Address - Country:US
Practice Address - Phone:509-946-5918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor