Provider Demographics
NPI:1831374842
Name:MERCY, JENNIFER L (MHP, LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MERCY
Suffix:
Gender:F
Credentials:MHP, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W WASHINGTON ST # A
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:AR
Mailing Address - Zip Code:71701-3959
Mailing Address - Country:US
Mailing Address - Phone:870-836-2321
Mailing Address - Fax:870-837-1195
Practice Address - Street 1:301 W WASHINGTON ST # A
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:AR
Practice Address - Zip Code:71701-3959
Practice Address - Country:US
Practice Address - Phone:870-836-2321
Practice Address - Fax:870-837-1195
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0811088101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health