Provider Demographics
NPI:1902496144
Name:CARMICKLE, MERVIL L (MSSW)
Entity Type:Individual
Prefix:MR
First Name:MERVIL
Middle Name:L
Last Name:CARMICKLE
Suffix:
Gender:M
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 COUNTRY CLUB RD SE
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-1705
Mailing Address - Country:US
Mailing Address - Phone:812-738-2114
Mailing Address - Fax:812-738-2119
Practice Address - Street 1:535 COUNTRY CLUB RD SE
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-1705
Practice Address - Country:US
Practice Address - Phone:812-738-2114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health