Provider Demographics
NPI:1558144287
Name:MERRILL, ANNAMARIE CALLAIS
Entity Type:Individual
Prefix:
First Name:ANNAMARIE
Middle Name:CALLAIS
Last Name:MERRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 KINGS COUNTY DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5785
Mailing Address - Country:US
Mailing Address - Phone:559-415-6737
Mailing Address - Fax:
Practice Address - Street 1:450 KINGS COUNTY DR STE 104
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5785
Practice Address - Country:US
Practice Address - Phone:559-415-6737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116314101YM0800X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health