Provider Demographics
NPI:1922325968
Name:LIND, MERRY ASHLEY (PHD, LPC-S)
Entity Type:Individual
Prefix:
First Name:MERRY
Middle Name:ASHLEY
Last Name:LIND
Suffix:
Gender:F
Credentials:PHD, LPC-S
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:LIND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, LPC-S
Mailing Address - Street 1:3611 SWISS AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-6245
Mailing Address - Country:US
Mailing Address - Phone:214-818-2600
Mailing Address - Fax:214-823-4819
Practice Address - Street 1:3611 SWISS AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-6245
Practice Address - Country:US
Practice Address - Phone:214-818-2600
Practice Address - Fax:214-823-4819
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15478101YM0800X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX15478OtherPROFESSIONAL LICENSE