Provider Demographics
NPI:1487687174
Name:MERCLAN PLLC
Entity Type:Organization
Organization Name:MERCLAN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MO
Authorized Official - Phone:502-241-2909
Mailing Address - Street 1:PO BOX 73070
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0002
Mailing Address - Country:US
Mailing Address - Phone:502-241-2909
Mailing Address - Fax:502-241-6811
Practice Address - Street 1:6200 CRESTWOOD STA
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-7418
Practice Address - Country:US
Practice Address - Phone:502-241-2909
Practice Address - Fax:502-241-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X
KY103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY659444007Medicaid
KY659444007Medicaid