Basic Information
| Provider Information | |||||||||
| NPI: | 1205302189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRIGAN | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | ELAINE | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11731 CLOVIS CT | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976039411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412815126 | ||||||||
| FaxNumber: | 5418841105 | ||||||||
| Practice Location | |||||||||
| Address1: | 3647 HIGHWAY 39 | ||||||||
| Address2: | |||||||||
| City: | KLAMATH FALLS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 976032612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418845244 | ||||||||
| FaxNumber: | 5418841105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2018 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C4145 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.