Provider Demographics
NPI:1134761398
Name:MERCER, MACKENZIE (MA)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7356 ARBOR TRL APT 208
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1598
Mailing Address - Country:US
Mailing Address - Phone:616-902-5339
Mailing Address - Fax:
Practice Address - Street 1:5625 WATER TOWER PL STE 310
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-2674
Practice Address - Country:US
Practice Address - Phone:248-762-5820
Practice Address - Fax:888-375-2104
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301017065103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling