Provider Demographics
NPI:1154378446
Name:MERZ, EDWARD A (LPC)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:A
Last Name:MERZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:ED
Other - Middle Name:A
Other - Last Name:MERZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:200 HICKORY STREET
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-2101
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:200 HICKORY STREET
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-2101
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3964-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1154378446Medicaid