Provider Demographics
NPI:1285717041
Name:MERKEL, JEANETTE H (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:H
Last Name:MERKEL
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DUESENBERG DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362
Mailing Address - Country:US
Mailing Address - Phone:805-378-7205
Mailing Address - Fax:805-497-4647
Practice Address - Street 1:141 DUESENBERG DR
Practice Address - Street 2:SUITE 2
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:805-378-7205
Practice Address - Fax:805-497-4647
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13983103TC0700X
CAMFC24039106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY139830Medicaid
CACP13983Medicare ID - Type Unspecified
CAPSY139830Medicaid