Provider Demographics
NPI:1083163026
Name:MERSINO, KRISTI M (MS)
Entity Type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:M
Last Name:MERSINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 QUEENS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:ROGUE RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97537-6644
Mailing Address - Country:US
Mailing Address - Phone:541-973-7632
Mailing Address - Fax:
Practice Address - Street 1:371 QUEENS BRANCH RD
Practice Address - Street 2:
Practice Address - City:ROGUE RIVER
Practice Address - State:OR
Practice Address - Zip Code:97537-6644
Practice Address - Country:US
Practice Address - Phone:541-973-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORC7784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional