Basic Information
| Provider Information | |||||||||
| NPI: | 1043385503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRIMAN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | BRENT | ||||||||
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| Credential: | M.A., LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14465 WACO ST NW | ||||||||
| Address2: | |||||||||
| City: | RAMSEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553036179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7633706307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6341 UNIVERSITY AVE NE | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554324946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126726999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 03/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 2023 | MN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.