Provider Demographics
NPI:1891334108
Name:MERRILL, JAMIE ALANE (MA, LPC, IMH-E)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:ALANE
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MA, LPC, IMH-E
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:ALANE
Other - Last Name:SNEDEGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC, IMH-E
Mailing Address - Street 1:1214 GREENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3037
Mailing Address - Country:US
Mailing Address - Phone:517-745-1115
Mailing Address - Fax:
Practice Address - Street 1:1214 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3037
Practice Address - Country:US
Practice Address - Phone:517-745-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401013896OtherLICENSED PROFESSIONAL COUNSELOR LPC