Basic Information
| Provider Information | |||||||||
| NPI: | 1982739306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUNTER | ||||||||
| FirstName: | MERRI | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 3313 MARY JANE DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652022729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738866118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15899 LOGANS LAKE RD | ||||||||
| Address2: | |||||||||
| City: | BOONVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652332866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6608822333 | ||||||||
| FaxNumber: | 6608822333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 02/18/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 2007001280 | MO | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101Y00000X | 2007001280 | MO | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 506201904 | 01 | MO | HCY MEDICAID NUMBER | OTHER | 499272003 | 05 | MO | MEDICAID | 1538204904 | 01 | MO | BVL LOCATION NPI NUMBER | OTHER | 1649269622 | 01 | MO | FCCMO BILLING NPI NUMBER | OTHER | 431008405 | 01 | MO | FCCMO TAX ID | OTHER |