Active NPI
Michelle Elaine Mersdorf, MS
- Counselor
- Lucedale, MS
National Provider Identifier
1538470190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1776
- Practice address
- 3236 Old 63 N
Lucedale, MS 39452-3682 - Phone
- (601) 766-0054
- NPI assigned
- Jun 29, 2010
- Last updated
- Jun 25, 2013
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1776 | MS | Primary |
Addresses
Primary practice location
3236 Old 63 N
Lucedale, MS 39452-3682
Mailing address
3236 Old 63 N
Lucedale, MS 39452-3682
Phone (601) 766-0054
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1776 | MS | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1277769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372118400000",
"number": "1538470190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3236 OLD 63 N",
"city": "LUCEDALE",
"state": "MS",
"postal_code": "394523682",
"telephone_number": "601-766-0054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3236 OLD 63 N",
"city": "LUCEDALE",
"state": "MS",
"postal_code": "394523682",
"telephone_number": "601-766-0054"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MERSDORF",
"first_name": "MICHELLE",
"middle_name": "ELAINE",
"name_prefix": "Mrs.",
"credential": "MS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-29",
"last_updated": "2013-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MS",
"license": "1776",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lucedale, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.