<Unavail>

LBN: Modern Mystic, Llc
<Unavail> is an health care organization with primary practice located at 2213 Brothers Rd , Santa Fe NM 87505-6993. The organization recently has only one registered license in Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center), which is considered as the primary health care specialty. Modern Mystic, Llc can be contacted via phone (505) 988-7616, or through Mercurio, Roxanne via phone (505) 231-3786.

Contact Information

Primary practice address
2213 Brothers Rd Santa Fe NM 87505-6993
Phone: (505) 988-7616
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Mercurio, Roxanne M.A.,L.M.H.C
Phone: (505) 231-3786

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Mental Health (Including Community Mental Health Center) 261QM0801X T-0174411 New Mexico

Profile Details

NPI number 1720445679
LBN Legal business name Modern Mystic, Llc
DBA Doing business as <Unavail>
Authorized official Mercurio, Roxanne M.A.,L.M.H.C
Entity Organization
Organization subpart 1 No
Enumeration date Jan 23rd, 2016
Last updated Jan 23rd, 2016 - about 10 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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