Provider Demographics
NPI:1811729627
Name:RESENDIZ, MERCEDES F (LPC)
Entity type:Individual
Prefix:MS
First Name:MERCEDES
Middle Name:F
Last Name:RESENDIZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 N RYDE AVE
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5098
Mailing Address - Country:US
Mailing Address - Phone:208-230-3377
Mailing Address - Fax:
Practice Address - Street 1:3676 N HARBOR LN STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-6919
Practice Address - Country:US
Practice Address - Phone:208-918-2743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6261670101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health