Provider Demographics
NPI:1154170934
Name:MERCILLE, TAYLAR MARIE (SSP)
Entity type:Individual
Prefix:
First Name:TAYLAR
Middle Name:MARIE
Last Name:MERCILLE
Suffix:
Gender:F
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 HAWTHORN AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1475
Mailing Address - Country:US
Mailing Address - Phone:636-626-4980
Mailing Address - Fax:
Practice Address - Street 1:1525 LOCUST ST
Practice Address - Street 2:
Practice Address - City:RED BUD
Practice Address - State:IL
Practice Address - Zip Code:62278-1374
Practice Address - Country:US
Practice Address - Phone:618-282-6251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2514041103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool