Provider Demographics
NPI:1972851038
Name:MERCER FAMILY RESOURCE CENTER, INC.
Entity type:Organization
Organization Name:MERCER FAMILY RESOURCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORI
Authorized Official - Middle Name:
Authorized Official - Last Name:COSNER-BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-265-7366
Mailing Address - Street 1:535 W YELLOWSTONE HWY
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-7507
Mailing Address - Country:US
Mailing Address - Phone:307-265-7366
Mailing Address - Fax:307-473-2650
Practice Address - Street 1:535 W YELLOWSTONE HWY
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-7507
Practice Address - Country:US
Practice Address - Phone:307-265-7366
Practice Address - Fax:307-473-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health