Provider Demographics
NPI:1609474634
Name:CLEMENT, MERCEDES LUDIVINA (LPCI)
Entity Type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:LUDIVINA
Last Name:CLEMENT
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:MS
Other - First Name:MERCEDES
Other - Middle Name:L
Other - Last Name:VILLEGAS DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6265 39TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4614
Mailing Address - Country:US
Mailing Address - Phone:409-962-4400
Mailing Address - Fax:409-962-4412
Practice Address - Street 1:6265 39TH ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4614
Practice Address - Country:US
Practice Address - Phone:409-962-4400
Practice Address - Fax:409-962-4412
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health