Provider Demographics
NPI:1063800696
Name:MERRILL, LINDSEY (RBT, SCMT, MT-BC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:RBT, SCMT, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N FORT LN APT 3
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-3291
Mailing Address - Country:US
Mailing Address - Phone:435-494-8096
Mailing Address - Fax:
Practice Address - Street 1:358 S 700 E STE B307
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102
Practice Address - Country:US
Practice Address - Phone:801-935-5796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-05
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
UT106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist