Active NPI
Sean Merrick
- Marriage & Family Therapist
- Grass Valley, CA
National Provider Identifier
1770138190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- AMFT119806
- Practice address
- 565 Brunswick Rd Ste 10
Grass Valley, CA 95945-9529 - Phone
- (530) 265-9057
- NPI assigned
- Aug 2, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Marriage & Family Therapist | 106H00000X | AMFT119806 | CA | Primary |
Addresses
Primary practice location
565 Brunswick Rd Ste 10
Grass Valley, CA 95945-9529
Mailing address
565 Brunswick Rd Ste 10
Grass Valley, CA 95945-9529
Phone (702) 575-2754
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2024 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMFT119806 | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705708800000",
"number": "1770138190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "565 BRUNSWICK RD STE 10",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459529",
"telephone_number": "702-575-2754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "565 BRUNSWICK RD STE 10",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959459529",
"telephone_number": "530-265-9057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERRICK",
"first_name": "SEAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-02",
"last_updated": "2024-01-20",
"certification_date": "2024-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "AMFT119806",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.