Active NPI
Jennifer Wallace Merrill, LAPC
- Mental Health Counselor
- Tyrone, GA
National Provider Identifier
1730466780
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LPC007657
- Practice address
- 120 Handley Rd
Tyrone, GA 30290-2177 - Phone
- (770) 486-1011
- NPI assigned
- Nov 4, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | APC002988 | GA | |
| Mental Health Counselor | 101YM0800X | LPC007657 | GA | Primary |
Addresses
Primary practice location
120 Handley Rd
Tyrone, GA 30290-2177
Mailing address
120 Handley Rd
Tyrone, GA 30290-2177
Phone (770) 486-1011
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 |
|---|---|---|---|
| APC002988 | GA | MD | Mental Health Counselor |
| LPC007657 | GA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320364800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1392076800000",
"number": "1730466780",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "120 HANDLEY RD",
"city": "TYRONE",
"state": "GA",
"postal_code": "302902177",
"telephone_number": "770-486-1011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 HANDLEY RD",
"city": "TYRONE",
"state": "GA",
"postal_code": "302902177",
"telephone_number": "770-486-1011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRILL",
"first_name": "JENNIFER",
"middle_name": "WALLACE",
"credential": "LAPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-11-04",
"last_updated": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "APC002988",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC007657",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyrone, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.