Provider Demographics
NPI:1104305895
Name:MERGERSON, TINA M (LMSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MERGERSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 BONNER ST
Mailing Address - Street 2:
Mailing Address - City:RUSK
Mailing Address - State:TX
Mailing Address - Zip Code:75785-2709
Mailing Address - Country:US
Mailing Address - Phone:903-941-0324
Mailing Address - Fax:
Practice Address - Street 1:296 BONNER ST
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-2709
Practice Address - Country:US
Practice Address - Phone:903-941-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56408104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker