Provider Demographics
NPI:1558851774
Name:MERCED, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:MERCED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 S PECOS RD
Mailing Address - Street 2:STE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2829
Mailing Address - Country:US
Mailing Address - Phone:702-251-8000
Mailing Address - Fax:
Practice Address - Street 1:6550 S PECOS RD
Practice Address - Street 2:STE 132
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2830
Practice Address - Country:US
Practice Address - Phone:312-999-8462
Practice Address - Fax:702-342-0936
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8895-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7554-SOtherLICENSE