Provider Demographics
NPI:1568299964
Name:MERCER, CHARLES RAY (LMSW)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAY
Last Name:MERCER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 NE INNSBRUCK DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-1940
Mailing Address - Country:US
Mailing Address - Phone:515-883-0106
Mailing Address - Fax:
Practice Address - Street 1:2340 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-5702
Practice Address - Country:US
Practice Address - Phone:515-235-5224
Practice Address - Fax:866-672-0706
Is Sole Proprietor?:No
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101859104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker