1376753541 NPI number — MS. ELIZABETH LYNNE MERRIWEATHER LMSW

Table of content: MS. ELIZABETH LYNNE MERRIWEATHER LMSW (NPI 1376753541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376753541 NPI number — MS. ELIZABETH LYNNE MERRIWEATHER LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MERRIWEATHER
Provider First Name:
ELIZABETH
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376753541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 W END AVE
Provider Second Line Business Mailing Address:
SUITE 126-241
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-1453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-877-5955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2817 W END AVE
Provider Second Line Business Practice Location Address:
SUITE 126-241
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37203-1453
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-877-5955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801072630 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LSW0000005520 . This is a "LCSW LICENSE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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