Provider Demographics
NPI:1497358568
Name:MERCK, JEAN ANN (LCP INTERN, LCDC)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:ANN
Last Name:MERCK
Suffix:
Gender:F
Credentials:LCP INTERN, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E HILLJE ST
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-4503
Mailing Address - Country:US
Mailing Address - Phone:979-253-3849
Mailing Address - Fax:979-534-2204
Practice Address - Street 1:403 E HILLJE ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-4503
Practice Address - Country:US
Practice Address - Phone:979-253-3849
Practice Address - Fax:979-534-2204
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81865101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional