Provider Demographics
NPI:1740419035
Name:MERCER, JAMES (CCDC,AMS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MERCER
Suffix:
Gender:M
Credentials:CCDC,AMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1852
Mailing Address - Country:US
Mailing Address - Phone:254-421-4774
Mailing Address - Fax:
Practice Address - Street 1:3000 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1852
Practice Address - Country:US
Practice Address - Phone:254-421-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A101Y00000X, 101YA0400X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral