Provider Demographics
NPI:1376168583
Name:MERCURE, CAITLIN (LICENSED MENTAL HEAL)
Entity Type:Individual
Prefix:MS
First Name:CAITLIN
Middle Name:
Last Name:MERCURE
Suffix:
Gender:F
Credentials:LICENSED MENTAL HEAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:TIERRA AMARILLA
Mailing Address - State:NM
Mailing Address - Zip Code:87575
Mailing Address - Country:US
Mailing Address - Phone:575-588-7252
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 84
Practice Address - Street 2:COUNTY ROAD 0324 #14
Practice Address - City:TIERRA AMARILLA
Practice Address - State:NM
Practice Address - Zip Code:87575
Practice Address - Country:US
Practice Address - Phone:575-588-7252
Practice Address - Fax:575-588-9132
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator