Provider Demographics
NPI:1346726361
Name:HORACE, MERCEDES ROYLETTA (LCAC)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:ROYLETTA
Last Name:HORACE
Suffix:
Gender:F
Credentials:LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 E 151ST ST APT 11
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7783
Mailing Address - Country:US
Mailing Address - Phone:219-484-5803
Mailing Address - Fax:
Practice Address - Street 1:2237 E 151ST ST APT 11
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7783
Practice Address - Country:US
Practice Address - Phone:219-484-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001169A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)