Provider Demographics
NPI:1700346632
Name:KATIE MERRICKS COUNSELING, LLC
Entity Type:Organization
Organization Name:KATIE MERRICKS COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC, NCC
Authorized Official - Phone:727-228-2388
Mailing Address - Street 1:1700 N MCMULLEN BOOTH RD STE C1
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-2129
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 N MCMULLEN BOOTH RD STE C1
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-2129
Practice Address - Country:US
Practice Address - Phone:727-228-2388
Practice Address - Fax:727-228-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1902259740Medicaid