Provider Demographics
NPI:1366509085
Name:MERCURY CENTER INC.
Entity Type:Organization
Organization Name:MERCURY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:317-881-5050
Mailing Address - Street 1:896 E MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1440
Mailing Address - Country:US
Mailing Address - Phone:317-881-5050
Mailing Address - Fax:
Practice Address - Street 1:896 E MAIN ST
Practice Address - Street 2:SUITE 6
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1440
Practice Address - Country:US
Practice Address - Phone:317-881-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040086103TB0200X
IN34000809A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN06839200OtherMAGELLAN
IN2200000203363OtherANTHEM