Provider Demographics
NPI:1548457336
Name:MERCER, WALT (PHD)
Entity type:Individual
Prefix:DR
First Name:WALT
Middle Name:
Last Name:MERCER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 THORPE LN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7113
Mailing Address - Country:US
Mailing Address - Phone:512-558-7770
Mailing Address - Fax:512-558-7773
Practice Address - Street 1:1341 THORPE LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7113
Practice Address - Country:US
Practice Address - Phone:512-558-7770
Practice Address - Fax:512-558-7773
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25814103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist