Provider Demographics
NPI:1720556244
Name:MERRIMAN, KATELYNN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ELIZABETH
Last Name:MERRIMAN
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 1:3834 CASA BLANCA CT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78418-4000
Mailing Address - Country:US
Mailing Address - Phone:240-993-6449
Mailing Address - Fax:
Practice Address - Street 1:6200 SARATOGA BLVD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3421
Practice Address - Country:US
Practice Address - Phone:361-356-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4961103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst