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Individual

MS. DONNA MERRITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1310 KINGS COVE CT, INDIANAPOLIS, IN 46260-1671
(317) 581-1558
Mailing address
1310 KINGS COVE CT, INDIANAPOLIS, IN 46260-1671
(317) 581-1558

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
70000074A
IN
2084P0800X
Psychiatry Physician
70000074
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000607200
ANTHEM PIN NUMBER
IN
01
2004599330A
MEDICAID GROUP#
IN
05
200912330
IN
Enumeration date
06/17/2008
Last updated
07/20/2010
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