Provider Demographics
NPI:1750431763
Name:MERCED COUNSELING, INC.
Entity type:Organization
Organization Name:MERCED COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-277-3117
Mailing Address - Street 1:1342 COLONIAL BLVD
Mailing Address - Street 2:BUILDING F SUITE 41A
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1013
Mailing Address - Country:US
Mailing Address - Phone:239-277-3117
Mailing Address - Fax:239-936-2696
Practice Address - Street 1:1342 COLONIAL BLVD
Practice Address - Street 2:BUILDING F SUITE 41A
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1013
Practice Address - Country:US
Practice Address - Phone:239-277-3117
Practice Address - Fax:239-936-2696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW81291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AB504Medicare PIN