Healthcare Provider Details

I. General information

NPI: 1144186776
Provider Name (Legal Business Name): TERIAHNA MERCADO LEXI MERCADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N GREENLEAF ST
GURNEE IL
60031-3326
US

IV. Provider business mailing address

105 N GREENLEAF ST
GURNEE IL
60031-3326
US

V. Phone/Fax

Practice location:
  • Phone: 630-465-3963
  • Fax:
Mailing address:
  • Phone: 847-376-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCAB915859
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: