Provider Demographics
NPI:1104230739
Name:MERCER, SHANA R (MED, LPC-S)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:R
Last Name:MERCER
Suffix:
Gender:F
Credentials:MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 PINE ST STE 760
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-2421
Mailing Address - Country:US
Mailing Address - Phone:409-223-1433
Mailing Address - Fax:409-203-4002
Practice Address - Street 1:350 PINE ST STE 760
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-2421
Practice Address - Country:US
Practice Address - Phone:409-223-1413
Practice Address - Fax:409-203-4002
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX70111101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33853001Medicaid