Provider Demographics
NPI:1780082941
Name:MERCER, MARCY ELIZABETH (LAC)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:ELIZABETH
Last Name:MERCER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MARCY
Other - Middle Name:ELIZABETH
Other - Last Name:TODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:2607 CADDO ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ARKADELPHIA
Mailing Address - State:AR
Mailing Address - Zip Code:71923-5307
Mailing Address - Country:US
Mailing Address - Phone:870-230-8217
Mailing Address - Fax:870-230-8201
Practice Address - Street 1:2607 CADDO ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ARKADELPHIA
Practice Address - State:AR
Practice Address - Zip Code:71923-5307
Practice Address - Country:US
Practice Address - Phone:870-230-8217
Practice Address - Fax:870-230-8201
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1412161101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health