Provider Demographics
NPI:1972172088
Name:MERKLING, BENJAMIN J (LP)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:MERKLING
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 METRO BLVD
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3025
Mailing Address - Country:US
Mailing Address - Phone:651-353-5201
Mailing Address - Fax:
Practice Address - Street 1:7401 METRO BLVD
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-3025
Practice Address - Country:US
Practice Address - Phone:651-353-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6340101YM0800X, 103T00000X
103TE1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports