Healthcare Provider Details

I. General information

NPI: 1760688667
Provider Name (Legal Business Name): JESSICA STEVENS MERCADO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/01/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 MARY KAY BLVD
BENTON AR
72015-7201
US

IV. Provider business mailing address

PO BOX 1589
BENTON AR
72018-1589
US

V. Phone/Fax

Practice location:
  • Phone: 501-315-3344
  • Fax:
Mailing address:
  • Phone: 501-315-3344
  • Fax: 870-917-2161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number3349-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: