MEDICARE: BRIAN EUGENE SELZLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	SWB-2025-0973	NM

General Provider Information

NPI Number	:	1114808367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN EUGENE SELZLER

Provider Business Mailing Address
First Line	:	385 CALLE DE ALEGRA BLDG A
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3423
Country	:	US
Telephone Number	:	575-526-1105
Fax Number	:	575-524-4266

Provider Business Practice Location Address
First Line	:	1750 EL PASEO RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-6012
Country	:	US
Telephone Number	:	575-459-1751
Fax Number	:	855-538-1790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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