Provider Demographics
NPI:1386338341
Name:MERTZ-ENGLAND, MADISON
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:MERTZ-ENGLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:
Other - Last Name:MERTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:627 CLARA AVE APT 101
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1943
Mailing Address - Country:US
Mailing Address - Phone:573-673-0440
Mailing Address - Fax:
Practice Address - Street 1:3460 HAMPTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-1938
Practice Address - Country:US
Practice Address - Phone:314-669-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO101Y00000X, 101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional