Basic Information
| Provider Information | |||||||||
| NPI: | 1053469320 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERKEL | ||||||||
| FirstName: | CARMELLA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 192 | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601840192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307428271 | ||||||||
| FaxNumber: | 7738681580 | ||||||||
| Practice Location | |||||||||
| Address1: | 3139 N LINCOLN AVE | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606573114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307428271 | ||||||||
| FaxNumber: | 7738681580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 180-005882 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.