Provider Demographics
NPI:1669897427
Name:MERRITT, ELIZABETH (MA, QMHP-R, CADCIII)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MA, QMHP-R, CADCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-952-1719
Mailing Address - Fax:541-684-4162
Practice Address - Street 1:230 N 3RD ST STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9679
Practice Address - Country:US
Practice Address - Phone:541-952-1719
Practice Address - Fax:541-684-4162
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-03
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500699658Medicaid