Provider Demographics
NPI:1619265014
Name:MERRELL, BRIGITTE (MFT)
Entity Type:Individual
Prefix:
First Name:BRIGITTE
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2577 SAN PABLO AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1159
Mailing Address - Country:US
Mailing Address - Phone:510-508-6643
Mailing Address - Fax:
Practice Address - Street 1:150 HARBOUR WAY STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94801-3554
Practice Address - Country:US
Practice Address - Phone:510-508-6643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist