Healthcare Provider Details

I. General information

NPI: 1205588944
Provider Name (Legal Business Name): MARY LENEIL MERCER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2022
Last Update Date: 01/24/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 TIOGA RD
BALL LA
71405-3978
US

IV. Provider business mailing address

3330 MASONIC DR
ALEXANDRIA LA
71301-3841
US

V. Phone/Fax

Practice location:
  • Phone: 318-640-6942
  • Fax:
Mailing address:
  • Phone: 318-448-6530
  • Fax: 318-483-4044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLPC7881
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: