Provider Demographics
NPI:1932123130
Name:ANDERSON, MERRILL PAUL (PHD)
Entity Type:Individual
Prefix:MR
First Name:MERRILL
Middle Name:PAUL
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 WEST LOOP S STE 430
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2403
Mailing Address - Country:US
Mailing Address - Phone:713-444-1047
Mailing Address - Fax:713-661-1324
Practice Address - Street 1:5959 WEST LOOP S STE 430
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2403
Practice Address - Country:US
Practice Address - Phone:713-444-1047
Practice Address - Fax:713-661-1324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22182103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B3862Medicare ID - Type UnspecifiedTPI-FT.BEND COUNTY
TX8B4083Medicare ID - Type UnspecifiedTPI-HARRIS COUNTY
TX8D2562Medicare ID - Type UnspecifiedTPI-GALVESTON COUNTY
TX8D2561Medicare ID - Type UnspecifiedTPI-BRAZORIA COUNTY