Provider Demographics
NPI:1659991537
Name:MERCER, CARLYE GAIL
Entity Type:Individual
Prefix:MISS
First Name:CARLYE
Middle Name:GAIL
Last Name:MERCER
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 1:1901 PARKVIEW AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4806
Mailing Address - Country:US
Mailing Address - Phone:269-225-5148
Mailing Address - Fax:
Practice Address - Street 1:1901 PARKVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4806
Practice Address - Country:US
Practice Address - Phone:269-225-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401222683101Y00000X
MI4101007265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor