Organization · Type 2 NPI
Modern Mystic, LLC
Mental Health Clinic/Center (Including Community Mental Health Center) · Santa Fe, NM
NPI number
1720445679
Active
Practice location
2213 Brothers Rd
Santa Fe, NM 87505-6993
Mailing address
9 Bonito Rd
Santa Fe, NM 87508-8793
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) Primary | 261QM0801X | T-0174411 (NM) |
Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...
4 other providers at this address
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About NPI 1720445679
Modern Mystic, LLC's National Provider Identifier is 1720445679, issued on Jan 23, 2016. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Santa Fe, NM. The record was last updated on Jan 23, 2016.