Provider Demographics
NPI:1821212408
Name:MERRILL, NANCY J (MA, MED, LMHC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MA, MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 NE 180TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-4027
Mailing Address - Country:US
Mailing Address - Phone:206-365-1758
Mailing Address - Fax:
Practice Address - Street 1:11415 NE 128TH ST STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-6314
Practice Address - Country:US
Practice Address - Phone:425-820-5150
Practice Address - Fax:425-823-3948
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 00003447101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health