Provider Demographics
NPI:1114679032
Name:OVERCASH-THOM, MERICA JOY (LMFT)
Entity Type:Individual
Prefix:
First Name:MERICA
Middle Name:JOY
Last Name:OVERCASH-THOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 4TH ST E STE 301
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1771
Mailing Address - Country:US
Mailing Address - Phone:651-318-0109
Mailing Address - Fax:
Practice Address - Street 1:275 4TH ST E STE 301
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1771
Practice Address - Country:US
Practice Address - Phone:651-318-0109
Practice Address - Fax:651-344-0515
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21-467221700000X
MN4259106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist