Healthcare Provider Details

I. General information

NPI: 1205763828
Provider Name (Legal Business Name): JENNY MERCER LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15150 W PARK PL # 2034
GOODYEAR AZ
85395-2385
US

IV. Provider business mailing address

614 S 119TH AVE
AVONDALE AZ
85323-5716
US

V. Phone/Fax

Practice location:
  • Phone: 623-759-0290
  • Fax:
Mailing address:
  • Phone: 360-584-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-24118
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: