Provider Demographics
NPI:1689283582
Name:MERCADO, ANGEL RAY
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:RAY
Last Name:MERCADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 EVERGREEN FARM DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-5359
Mailing Address - Country:US
Mailing Address - Phone:254-458-4841
Mailing Address - Fax:
Practice Address - Street 1:320 WESTWAY PL STE 530
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1000
Practice Address - Country:US
Practice Address - Phone:817-516-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health