Provider Demographics
NPI:1295280493
Name:MERRICK, MATTHEW O (LPC, NCC)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:O
Last Name:MERRICK
Suffix:
Gender:M
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4160 E SCHROEDER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85739-9507
Mailing Address - Country:US
Mailing Address - Phone:520-248-1744
Mailing Address - Fax:520-448-0719
Practice Address - Street 1:4160 E SCHROEDER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9507
Practice Address - Country:US
Practice Address - Phone:520-248-1744
Practice Address - Fax:520-448-0719
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health