Provider Demographics
NPI:1003117722
Name:MERCER, JEFFERY T (MA)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:T
Last Name:MERCER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11003 PERWINKLE LANE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-4104
Mailing Address - Country:US
Mailing Address - Phone:502-618-2620
Mailing Address - Fax:
Practice Address - Street 1:11003 PERWINKLE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4104
Practice Address - Country:US
Practice Address - Phone:502-618-2620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0549103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY-0549OtherKY-0549