Healthcare Provider Details

I. General information

NPI: 1487687174
Provider Name (Legal Business Name): MERCLAN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 CRESTWOOD STA SUITE A
CRESTWOOD KY
40014-7418
US

IV. Provider business mailing address

PO BOX 73070
CLEVELAND OH
44193-0002
US

V. Phone/Fax

Practice location:
  • Phone: 502-241-2909
  • Fax: 502-241-6811
Mailing address:
  • Phone: 502-241-2909
  • Fax: 502-241-6811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number StateKY

VIII. Authorized Official

Name: JEFFERY T MERCER
Title or Position: OWNER/PRESIDENT
Credential: M.O.
Phone: 502-241-2909