Provider Demographics
NPI:1649382938
Name:MERCHANT, ALBERT W (LCSW)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:W
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 N. CENTRAL EXPWY
Mailing Address - Street 2:STE 203
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-8600
Mailing Address - Country:US
Mailing Address - Phone:214-503-9222
Mailing Address - Fax:214-503-7788
Practice Address - Street 1:10300 N. CENTRAL EXPWY
Practice Address - Street 2:STE 203
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-8600
Practice Address - Country:US
Practice Address - Phone:214-503-9222
Practice Address - Fax:214-503-7788
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX115491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX064024501Medicaid
TX064024501Medicaid