Provider Demographics
NPI:1902229149
Name:MERTENS, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MERTENS
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 1:124 W 46TH ST # 7
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8348
Mailing Address - Country:US
Mailing Address - Phone:402-337-4717
Mailing Address - Fax:
Practice Address - Street 1:124 W 46TH ST # 7
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:402-337-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-23
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1889101YA0400X
NE169101YM0800X
NE4640101YM0800X
NE1546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE470398819Medicaid