Provider Demographics
NPI:1124457072
Name:MERCADO, JERRY (PHD, LPC, NCC)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:MERCADO
Suffix:
Gender:
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10802 MISTY SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77086-1923
Mailing Address - Country:US
Mailing Address - Phone:787-308-7430
Mailing Address - Fax:
Practice Address - Street 1:2021 GUADALUPE ST STE 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5654
Practice Address - Country:US
Practice Address - Phone:787-308-7430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2025-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88646101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1307576Medicaid
MA1303295Medicaid
M18463OtherBLUE CROSS BLUE SHIELD
Y10086Medicare PIN