Provider Demographics
NPI:1770051500
Name:MERKLEY, CALE CORTLAN (MSW)
Entity type:Individual
Prefix:
First Name:CALE
Middle Name:CORTLAN
Last Name:MERKLEY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 TOWER RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65669-8333
Mailing Address - Country:US
Mailing Address - Phone:509-270-1469
Mailing Address - Fax:
Practice Address - Street 1:155 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MO
Practice Address - Zip Code:65753-8104
Practice Address - Country:US
Practice Address - Phone:417-634-4203
Practice Address - Fax:417-634-4505
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60897094101YM0800X
WALW605635031041C0700X
MO20240179121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2116222Medicaid