Provider Demographics
NPI:1730593211
Name:MERRITT, JODI ANNE (LPC-MH, LAC)
Entity type:Individual
Prefix:MRS
First Name:JODI
Middle Name:ANNE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:LPC-MH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 S LOUISE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3144
Mailing Address - Country:US
Mailing Address - Phone:605-334-7713
Mailing Address - Fax:
Practice Address - Street 1:4300 S LOUISE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3144
Practice Address - Country:US
Practice Address - Phone:605-334-7713
Practice Address - Fax:605-334-5348
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD13071595101YA0400X
SDLPC-MH20281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575260Medicaid