Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | KY-0549 | KY |
NPI | 1003117722 |
---|---|
Provider Name | Mr. Jeffery T Mercer |
First Address | Louisville, KY 40291-4104 |
Second Address | Louisville, KY 40291-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2010 |
Last Update Date | 11/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KY-0549 | KY-0549 (01) | KY |