Provider Demographics
NPI:1699592998
Name:CLINE-ELLIOTT, MERENA K
Entity type:Individual
Prefix:
First Name:MERENA
Middle Name:K
Last Name:CLINE-ELLIOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:ELLENBORO
Mailing Address - State:WV
Mailing Address - Zip Code:26346-0093
Mailing Address - Country:US
Mailing Address - Phone:681-528-9127
Mailing Address - Fax:
Practice Address - Street 1:100 SCHOOL ST. BLDG B
Practice Address - Street 2:
Practice Address - City:ELLENBORO
Practice Address - State:WV
Practice Address - Zip Code:26346
Practice Address - Country:US
Practice Address - Phone:681-528-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2467-2074251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management