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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