Basic Information
| Provider Information | |||||||||
| NPI: | 1336499961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERCER | ||||||||
| FirstName: | JANELL | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1908 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098905930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1908 BUSINESS CENTER DR | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924083436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098905930 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2012 | ||||||||
| LastUpdateDate: | 12/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 72010 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 106H00000X | 97613 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 72010 | 01 | CA | MFT INTERN NUMBER | OTHER |