Provider Demographics
NPI:1639945728
Name:ANDERSON, MERCEDES (PHD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1772 E BOSTON ST STE 105
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-6243
Mailing Address - Country:US
Mailing Address - Phone:480-621-7257
Mailing Address - Fax:480-584-5825
Practice Address - Street 1:1772 E BOSTON ST STE 105
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-6243
Practice Address - Country:US
Practice Address - Phone:480-621-7257
Practice Address - Fax:480-584-5825
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist