Provider Demographics
NPI:1043020688
Name:THERAPIST JEN
Entity type:Organization
Organization Name:THERAPIST JEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, MA
Authorized Official - Phone:586-915-2546
Mailing Address - Street 1:22592 VAN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-2499
Mailing Address - Country:US
Mailing Address - Phone:586-915-2546
Mailing Address - Fax:
Practice Address - Street 1:22592 VAN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-2499
Practice Address - Country:US
Practice Address - Phone:586-915-2546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-07
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty