Provider Demographics
NPI:1487156618
Name:MERCER PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:MERCER PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:612-669-4015
Mailing Address - Street 1:5852 UPTON AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55410-2959
Mailing Address - Country:US
Mailing Address - Phone:612-669-4015
Mailing Address - Fax:
Practice Address - Street 1:410 E 48TH ST STE 3
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5651
Practice Address - Country:US
Practice Address - Phone:612-669-4015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-04
Last Update Date:2018-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5315103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty