Provider Demographics
NPI:1881181352
Name:MERRILL, KRISTIN LOUISE (LPC)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LOUISE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7570 BALES ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45069-7516
Mailing Address - Country:US
Mailing Address - Phone:513-914-4688
Mailing Address - Fax:
Practice Address - Street 1:7570 BALES ST # 380
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45069-7516
Practice Address - Country:US
Practice Address - Phone:513-914-4688
Practice Address - Fax:513-285-0199
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500881101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional