Provider Demographics
NPI:1699065698
Name:MERRILL, JARRED DAVID
Entity type:Individual
Prefix:
First Name:JARRED
Middle Name:DAVID
Last Name:MERRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9005 SALSBURY LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2050
Mailing Address - Country:US
Mailing Address - Phone:325-668-8553
Mailing Address - Fax:
Practice Address - Street 1:9005 SALSBURY LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-2050
Practice Address - Country:US
Practice Address - Phone:325-668-8553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health