Provider Demographics
NPI:1962924225
Name:MERRICK, KYMBERLY D (LPC)
Entity type:Individual
Prefix:
First Name:KYMBERLY
Middle Name:D
Last Name:MERRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 W VICTORY WAY
Mailing Address - Street 2:
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-3439
Mailing Address - Country:US
Mailing Address - Phone:970-824-2557
Mailing Address - Fax:
Practice Address - Street 1:2045 W VICTORY WAY
Practice Address - Street 2:
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-3439
Practice Address - Country:US
Practice Address - Phone:970-824-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0017999101YP2500X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No175T00000XOther Service ProvidersPeer Specialist