Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 0000914 | CO |
NPI | 1003470139 |
---|---|
Provider Name | Kim Ann Merrill |
First Address | Broomfield, CO 80023-4245 |
Second Address | Boulder, CO 80301-3375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2019 |
Last Update Date | 24/04/2019 |