Provider Demographics
NPI:1396473336
Name:MERRELL, ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:MERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MERRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ELIZABETH MERRELL
Mailing Address - Street 1:1711 E CENTRAL EXP, N CENTRAL EXP
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76541
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1711 E CENTRAL TEXAS EXPY STE 302
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-9147
Practice Address - Country:US
Practice Address - Phone:254-265-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty