Active NPI
James Merrill, LIC PSYCHOLOGIST
- Clinical Psychologist
- Charleston, WV
National Provider Identifier
1265716278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 452
- Practice address
- 511 Morris St
Charleston, WV 25301-1326 - Phone
- (304) 341-0511
- Fax
- (304) 341-0499
- NPI assigned
- Oct 10, 2011
- Last updated
- Oct 10, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 452 | WV | Primary |
Addresses
Primary practice location
511 Morris St
Charleston, WV 25301-1326
Mailing address
511 Morris St
Charleston, WV 25301-1326
Phone (304) 341-0511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0005355002 | Medicaid | WV |
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)
- Enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 452 | WV | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318204800000",
"number": "1265716278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 MORRIS ST",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011326",
"telephone_number": "304-341-0511",
"fax_number": "304-341-0499"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 MORRIS ST",
"city": "CHARLESTON",
"state": "WV",
"postal_code": "253011326",
"telephone_number": "304-341-0511",
"fax_number": "304-341-0499"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRILL",
"first_name": "JAMES",
"credential": "LIC PSYCHOLOGIST",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-10-10",
"last_updated": "2011-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WV",
"license": "452",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0005355002",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charleston, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 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.