Provider Demographics
NPI:1306546353
Name:MERCURY MENTAL HEALTH LLC
Entity type:Organization
Organization Name:MERCURY MENTAL HEALTH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PARMENTER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:812-821-7130
Mailing Address - Street 1:358 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:IN
Mailing Address - Zip Code:47460-1814
Mailing Address - Country:US
Mailing Address - Phone:812-821-7130
Mailing Address - Fax:970-540-5636
Practice Address - Street 1:205 N COLLEGE AVE STE 216
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3955
Practice Address - Country:US
Practice Address - Phone:720-254-1353
Practice Address - Fax:949-695-2240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty