Active NPI
Daniella M Merzlock, LPC
- Professional Counselor
- Chubbuck, ID
National Provider Identifier
1194092486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC-4867
- Practice address
- 4460 Central Way
Ste 2
Chubbuck, ID 83202 - Phone
- (208) 237-1711
- NPI assigned
- Nov 30, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC-4867 | ID | Primary |
Addresses
Primary practice location
4460 Central Way
Ste 2
Chubbuck, ID 83202
Mailing address
PO Box 4908
Pocatello, ID 83205-4908
Phone (208) 237-1711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC-4867 | ID | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322611200000",
"number": "1194092486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4908",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832054908",
"telephone_number": "208-237-1711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4460 CENTRAL WAY",
"address_2": "STE 2",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "83202",
"telephone_number": "208-237-1711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERZLOCK",
"first_name": "DANIELLA",
"middle_name": "M",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-30",
"last_updated": "2011-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ID",
"license": "LPC-4867",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.