Provider Demographics
NPI:1629559851
Name:MERRELL, LINDSAY R (LCSW)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:R
Last Name:MERRELL
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 1:4508 E WALTER WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-8819
Mailing Address - Country:US
Mailing Address - Phone:443-987-0058
Mailing Address - Fax:
Practice Address - Street 1:3610 N 44TH ST STE 140
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-6041
Practice Address - Country:US
Practice Address - Phone:602-218-6901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-171211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical