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NPI Code Detail

MEDICARE: PABLO MERCADO

MEDICARE: PABLO MERCADO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor178015993IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11821597063OTHERILPRIVATE

General Provider Information

NPI Number : 1124765508
Entity Type Code : Individual
Provider Name (Legal Business Name) : PABLO MERCADO
Provider Business Mailing Address
First Line : 209 WILLOW BLVD
Second Line :
City : WILLOW SPRINGS
State : IL
Zip : 60480-1627
Country : US
Telephone Number : 830-290-3436
Fax Number :
Provider Business Practice Location Address
First Line : 2319 S DAMEN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60608-4209
Country : US
Telephone Number : 872-281-7575
Fax Number : 773-801-0084
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/17/2022
Last Update Date : 05/17/2022

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Directions to “ PABLO MERCADO ” Practice Location

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