Provider Demographics
NPI:1649728718
Name:MERCER, CORRINNE (BCBA)
Entity type:Individual
Prefix:
First Name:CORRINNE
Middle Name:
Last Name:MERCER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5517 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-2239
Mailing Address - Country:US
Mailing Address - Phone:940-363-9788
Mailing Address - Fax:
Practice Address - Street 1:10338 E 11TH ST STE 105
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74128-3008
Practice Address - Country:US
Practice Address - Phone:918-601-5676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1-16-22938103K00000X
TX1292103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst