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Organization
MODERN MYSTIC, LLC
Active
Organization
MODERN MYSTIC, LLC
Active
Other names
Roxanne Mercurio
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ROXANNE MERCURIO M.A.,L.M.H.C (LICENSED MENTAL HEALTH COUNSELOR)
(505) 231-3786
Entity
Organization
Contact information
Practice address
2213 BROTHERS RD, SANTA FE, NM 87505-6993
(505) 988-7616
Mailing address
9 BONITO RD, SANTA FE, NM 87508-8793
(505) 231-3786
(505) 988-5592
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
T-0174411
NM
Other
Enumeration date
01/23/2016
Last updated
01/23/2016
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