Provider Demographics
NPI:1356465868
Name:SAURBAUGH, MERCEDES B (LLMSW)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:B
Last Name:SAURBAUGH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:B
Other - Last Name:MERVENNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12048 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9661
Mailing Address - Country:US
Mailing Address - Phone:616-396-3391
Mailing Address - Fax:616-396-2315
Practice Address - Street 1:12048 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-9661
Practice Address - Country:US
Practice Address - Phone:616-396-3391
Practice Address - Fax:616-396-2315
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010887331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical