Doctor Name: | MICHAEL GEORGE MERCURY |
NPI Number: | 1104992445 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 071005518 |
Business Practice Address: | 25 N Winfield Rd Winfield, IL - 601901295 |
Business Phone Number: | 6309334056 |
Business Fax Number: | 6309334057 |
Mailing Address: | 25 N Winfield Rd, WINFIELD |
State: | IL |
Postal Code: | 601901295 |
Phone Number: | 6309334056 |
Fax Number: | 6309334057 |
NPI Enumeration Date: | 11/28/2006 |
NPI Last Update Date: | 11/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 071005518 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |