Provider Demographics
NPI:1366751166
Name:MERTZ, KARLY QUINN (MA)
Entity type:Individual
Prefix:MISS
First Name:KARLY
Middle Name:QUINN
Last Name:MERTZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3486
Mailing Address - Country:US
Mailing Address - Phone:707-444-8293
Mailing Address - Fax:707-444-8298
Practice Address - Street 1:2257 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-3486
Practice Address - Country:US
Practice Address - Phone:707-444-8293
Practice Address - Fax:707-444-8298
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA118092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor